THE  BTA''J:'US 


THE  MEDICAL  PROFESSION 


STATE   OJP  NEA¥  -YORK, 


HENKY   H.  PTFFARD,  M.  D. 


COLUMBIA  UNIVFRRITV 

DEPARTMENT  OF  PHYSIOLOGY 

College  of  Physicians  and  Surgeons 
437  west  fifty  ninth  street 

NEW  YORK 


NEW    YORK: 
D.     APPLKTON     AND     COMPANY, 

1,    3.    AND    5    BOND    STEEBT. 
1884. 


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CoUege  of  ^iipssiciang  anb  burgeons 

Xibrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

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http://www.archive.org/details/statusofmedicalpOOpiff 


THE  STATUS 


OF 


THE  MEDICAL  PROFESSION 


STATE   OF  ]SrEW  YORK. 


HENRY  G.  PIFFARD,  M.  D. 


NEW    YORK: 
D.     APPLETON    AND     COMPANY, 

1,   3,:and   5   BOND    STEEET. 
188  3. 


THE  STATUS  OF 

THE  MEDICAL  PROFESSION" 

IN   THE 

STATE  OF  E'EW  TOEK. 


FIRST  ARTICLE. 

From  the  Neio  York  Medical  Journal  for  April  IJj.^  1883. 

Comparatively  few  are  acquainted  witli  the  history  of  the  events  that 
led  to  the  movement  which  resulted  in  the  formulation  of  the  New  Code  of 
Ethics  of  the  Medical  Society  of  the  State  of  New  York.  The  writer  of 
this  considers  himself  fairly  well  informed  on  the  subject,  and  will  give 
what  appears  to  him  the  facts  pertaining  to  the  subject.  In  doing  this, 
however,  he  must  be  pardoned  for  certain  apparent  digressions,  since,  in 
order  that  the  matter  may  be  correctly  understood,  it  will  be  necessary  to 
go  back  to  the  times  that  precede  the  promulgation  of  the  "  Old  Code." 

In  New  York  the  profession  first  became  organized  as  a  corporate  body 
in  the  year  1806,  and  seventeen  years  later  thought  fit  to  lay  down  a  set  of 
rules  for  the  government  of  its  members.  This  action  was  deemed  neces- 
sary in  order  to  control  some  who  appeared  to  regard  medicine  in  the  light 
of  a  trade  rather  than  a  profession,  and  who  were  regarded  by  their  stricter 
brethren  as  medical  freebooters  rather  than  physicians.  The  result  was  the 
enactment  in  1823  of  the  "System  of  Ethics  of  the  Medical  Society  of  the 
State  of  New  York."  This  "  system  "  or  code  inculcated  two  species  of 
obligation,  namely :  those  which  the  profession  should  bear  to  the  public, 
and  those  which  its  individual  members  should  hold  to  each  other.  This 
code  was  founded  on  and  was  an  adaptation  to  local  needs  of  an  English 
work  known  as  "  Percival's  Ethics."  At  this  time  there  was  little  cause  for 
uneasiness  on  the  part  of  those  who  with  propriety  might  be  called  "  regu- 
lar physicians,"  namely  :  those  who  were  graduates  of  medical  schools,  and 
those  who,  after  strict  examination,  were  "  licensed"  to  practice  the  profes- 


4  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

sion  by  the  bodies  having  due  authority  thus  to  license — to  wit,  the  county 
societies.  During  these  years,  however,  an  irregular  sect  had  come  up, 
outside  the  profession,  and  who  were  commonly  spoken  of  as  the  "  steam- 
doctors  "  and  "  herb-doctors."  ■  These  were  men  of  no  medical  acquire- 
ments, and  of  varying  degrees  of  honesty,  who  had  embraced  the  doctrines 
of  one  Samuel  Thomson,  hailing  from  Xew  England.  Their  chief  thera- 
peutic reliance  was  on  vigorous  sweats  with  the  free  use  of  lobelia  and  the 
utter  condemnation  of  mineral  and  certain  other  powerful  drags.  The 
clamor  that  they  raised  against  the  heroic  treatment  then  practiced  by  the 
mass  of  the  profession  resulted  in  a  most  bitter  feud,  in  which  the  laity,  as 
is  usually  the'  case,  took  an  active  interest.  The  State  government  was 
appealed  to,  and  for  nearly  twenty  years  the  strife  was  kept  up,  sometimes 
the  profession  and  sometimes  the  quacks  being  ahead.  In  1827,  however, 
the  profession  gained  a  definite  and  substantial  victory,  the  medical  act  of 
that  year  placing  in  their  hands  the  supreme  control  and  regulation  of  the 
practice  of  medicine  in  this  State.  At  this  time  the  State  society  had  less 
power  over  the  county  societies  than  at  present,  and  the  suppression  of 
quackery  was  A^rtually  left  in  the  hands  of  the  county  societies,  each  having 
jurisdiction  in  its  own  district.  The  war  against  the  irregulars,  just  men- 
tioned, was  kept  up  with  more  or  less  vigor  in  different  localities.  During 
the  fourth  decade  of  this  century,  however,  a  new  form  of  irregularity  ap- 
peared. I  refer  to  the  introduction  of  Hahnemannism  or  Homoeopathy  ;  terms 
which  in  those  days  were  synonymous.  This  new  form  of  heresy  developed, 
not  among  the  irregulars,  but  in  the  bosom  of  the  profession  itself.  The  ad- 
herents and  advocates  of  the  new  doctrines  were  members  in  good  standing 
of  the  county  societies,  and  their  brethren  were  unable  to  invoke  the  aid  of 
the  law  to  compel  them  to  practice  in  accordance  with  the  views  and  wishes 
of  the  majority.  Another  weapon,  however,  was  brought  into  play,  namely  : 
social  and  professional  ostracism.  The  public,  as  before,  became  interested 
in  the  quarrel.  Many  of  the  laity  regarded  the  action  of  the  majority  as  a 
species  of  oppression,  and,  as  often  happens,  became  partisans  of  the  weaker 
party.  During  this  decade  the  number  of  professed  homoeopaths  increased 
and  their  adherents  and  supporters  multiplied.  The  heretics  were  still 
members  of  the  county  societies,  and  there  was  no  easy  way  of  ridding  the 
societies  of  them — that  is,  against  their  will.  At  that  time  the  only  way 
in  which  a  member  could  be  expelled  from  a  society,  and  prevented  from 
continuing  his  practice,  was  through  a  direct  application  to  the  courts.  The 
courts,  however,  were  unable  or  unwilKng  to  give  the  societies  the  desired 
relief,  feeling,  perhaps,  that  they  had  no  more  rigbt  to  interfere  in  matters 
of  professional  than  of  religious  heresy.  The  societies,  nevertheless,  pos- 
sessed one  valuable  franchise :  They  could  prevent  any  new  comer  from 
practicing  in  their  respective  districts  if  they  saw  fit  to  do  so.  This  af^ 
forded  them  the  means,  as  they  thought,  of  preventing  the  increase  of 
homoeopathy  by  accessions  from  abroad.  About  the  year  1842  the  Orange 
County  society,  I  believe,  availed  itself  of  this  power ;  and  forbade  a  physi- 


IN  THE  STATE   OF  NEW   YORK.  5 

cian  of  homoeopathic  tendencies  from  practicing  in  that  county.  Fearing 
that  he  would  in  like  manner  be  prevented  from  practicing  in  the  other 
counties  of  the  State,  he  gathered  his  friends  together  and,  without  much 
difficulty,  procured  the  passage  in  1844  of  a  law  that  deprived  the  county 
societies  of  their  powers  in  this  respect.  This  law,  moreover,  went  much 
further  than  this,  as  it  repealed  the  penal  clause  of  the  act  of  1827  and  vir- 
tually permitted  any  who  chose,  whether  educated  or  not,  to  practice 
medicine  in  this  State.  This  permitted  quacks  of  all  sorts  and  descriptions 
to  ply  their  vocation  without  fear  of  molestation.  This  condition  of  affairs 
was  maintained  for  thirty  years,  and  there  can  be  little  doubt  that  this  was 
the  direct  result  of  the  injudicious  action  of  the  Orange  County  society,  in- 
dorsed as  it  was  by  the  then  general  sentiment  of  the  profession  throughout 
the  State.  Homoeopathy  now  had  free  scope  to  extend  its  influence,  and, 
as  the  evils  of  sectarian  medicine  were  most  keenly  felt  in  New  York  and 
Pennsylvania,  these  States  were  among  the  foremost  to  consider  how  they 
might  be  averted.  The  result  of  this  consideration  was  the  birth  of  the 
American  Medical  Association.  It  seemed  probable  to  this  association  that 
the  most  effective  blow  would  be  given  to  the  new-born  heresy,  if  the  pro- 
fession as  a  whole  combined  against  it.  It  seemed  necessary  that  the 
homoeopaths  as  a  body  should  be  absolutely  excommunicated  from  profes- 
sional recognition  and  intercourse,  and  that  the  public  at  large  should  know 
it.  In  the  code  of  ethics,  and  especially  in  the  "  consultation  "  clause,  this 
sentiment  crystallized.  It  was  thought  that  the  public,  knowing  that  con- 
sultations were  forbidden,  would  be  afraid  to  intrust  serious  cases  to  the 
care  of  a  homoeopath  who  might  be  scores  of  miles  distant  from  a  colleague 
with  whom  he  might  consult.  This  action  was,  to  say  the  least,  exceed- 
ingly unwise  as  judged  from  a  purely  medico-political  standpoint.  In  those 
days  the  chief  therapeutic  reliances  of  the  profession  were  bleeding,  purg- 
ing, puking,  blisters,  and  salivation.  In  contrast  to  this  the  homoeopath 
offered  medication  that  was  not  unpleasant  to  take,  nor,  apparently,  dis- 
turbing in  its  effects.  Is  it  a  wonder,  then,  that  many  persons,  finding 
themselves  but  trivially  affected  and  yet  desiring  professional  advice,  pre- 
ferred the  milder  to  the  severer  medication  ?  Happily  recovering,  they  felt 
emboldened  to  trust  even  severer  cases  to  the  homoeopath.  The  general 
profession,  however,  were  blind  to  the  teachings  of  these  every-day  occur- 
rences, and  it  was  not  until  Andral  demonstrated  in  the  hospitals  of  Paris 
that  no  treatment  was  preferable  in  certain  diseases  to  the  methods  in 
vogue,  that  medical  men  awakened  to  the  fact  that  in  many  cases  they 
were  doing  their  patients  harm  rather  than  good. 

In  England,  Sir  John  Forbes  learned  the  lesson,  and  endeavored  to 
teach  it  to  his  countrymen.  The  reward  he  reaped  was  the  scorn  and 
hatred  of  his  peers,  and,  after  his  death,  the  virtual  adoption  of  his  views 
(expectant  treatment)  by  a  succeeding  generation.  He  simply  taught  that 
entire  absence  of  treatment  was  often  better  than  the  heroic  methods 
practiced  by  his  colleagues.     During  these  years  the  homoeopaths,  despite 


^  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

tlie  opposition  of  the  profession,  increased  in  numbers  and  in  influence, 
and,  excluded  by  the  "code"  from  joining  the  existing  medical  corpora- 
tions, tbey  applied  to  the  State  for  authority  to  form  corporations  of  their 
own.  This  they  secured,  with  powers  co-extensive  and  identical  with  those 
possessed  by  the  older  societies.  Most  of  the  older  homoeopaths  joined 
the  new  organizations,  but  there  was  still  left  a  certain  leaven  of  un- 
righteousness, which  the  majority  desired  to  get  rid  of.  This  could  hardly 
be  accomplished  under  existing  laws,  as  the  societies  had  not  the  power 
to  prune  their  membership,  except  through  an  application  to  the  courts. 
This  was  felt  to  be  an  inconvenience,  and  the  Legislature  was  applied  to 
for  relief.  Through  the  exertions  of  Dr.  Oliver  White  and  others,  a  law 
was  enacted,  in  1866,  which  greatly  enlarged  the  powers  of  the  county 
societies  in  this  respect.  The  law  in  question  permitted  them  to  frame  by- 
laws (subject  to  the  supervision  of  the  State  society)  which  would  enable 
them  to  visit  expulsion  on  any  member  who  should  be  guilty  of  irregular 
practices.  The  term  "  irregular  practices  "  was  a  little  indefinite,  but  was 
commonly  understood  to  include  employing  remedies  or  methods  that  in 
any  way  resembled  or  savored  of  homosopathy.  In  the  year  following  the 
passage  of  the  act,  the  Westchester  Medical  Society  invoked  its  aid  to 
enable  them  to  get  rid  of  an  obnoxious  member  who  was  charged  with 
"irregular  practice  of  medicine."  Apparently  the  gravest  charge  against 
the  member  was  the  admitted  fact  "  that  he  has  purchased  globules  of 
sugar  of  milk  by  the  pound  from  the  Homoeopathic  Pharmacy  in  New  York 
City,"  and  "  that  he  used  these  homoeopathic  globules  in  his  practice,  to 
induce  his  children  patients  to  take  the  medicine  which  he  prescribed  for 
them."  On  these  charges  he  was  expelled  by  the  county  society,  and,  on 
the  member's  appeal  to  the  State  society,  the  action  of  the  county  society 
was  sustained.  The  expelled  member,  if  he  desired  professional  affiliation, 
was  now  forced  to  join  the  homoeopathic  society.  In  this  way  the  ranks 
of  that  body  obtained  occasional  recruits.  I  do  not  mean  that  there  were 
many  formal  prosecutions  for  the  crime  of  giving  the  children  a  little 
candy,  but  the  social  and  professional  pressure  was  so  great  that  many  left 
the  regular  societies  voluntarily,  in  order  that  they  might  obtain  a  little 
peace  from  persecution  and  be  enabled  to  practice  as  they  thought  best. 
It  is  a  curious  fact  that,  while  the  regular  societies  excluded  the  use  of  cer- 
tain medicines  and  modes  of  employing  them,  the  homoeopathic  societies 
were  really  more. liberal  in  this  respect,  none  of  them,  I  believe,  having 
formally  adopted  the  exclusive  tenets  of  Hahnemann,  or  declared  that  their 
members  must  practice  exclusively  in  accordance  with  the  doctrine  of  simi- 
lars. So  far  as  I  am  aware,  they  never  expelled  any  of  their  members  who 
found  that  "  confectionery  "  ("  Zuckerwaaren,"  as  the  decision  of  a  German 
court  of  justice  recently  tenned  it)  was  not  always  sufficient,  and  who  sup-- 
plemented  it  with  a  good  dose  of  quinine  or  calomel.  The  homoeopaths, 
then,  were,  practically  at  least,  less  exclusive  than  their  elder  brethren. 
Many  physicians,  who,  led  by  a  spirit  of  inquiry,  investigated  the  homoeo- 


IN  THE  STATE  OF  NEW  lOBK  ^ 

patliic  system,  found  some  apparently  striking  verifications  of  the  doctrine 
of  similars,  forthwith  fancied  that  in  these  consisted  the  whole  science  and 
art  of  medicine,  and  made  use  of  them  as  occasion  required.  This  led  to 
their  ethical  condemnation,  and  forced  them  into  the  established  homoeo- 
pathic organizations,  in  some  instances  long  before  they  had  any  settled 
convictions  on  the  subject.  There  is  little  doubt  that  the  general  effect  of 
the  "  code  "  was,  in  many  ways,  to  build  up  and  strengthen  the  sectarian 
societies,  not  only  by  forcing  men  into  them,  but  by  exciting  public  sym- 
pathy in  their  favor,  and  thus  aiding  them  politically.  A  house  divided 
against  itself  can  not  stand,  and  a  medical  profession  di^dded  into  hostile 
camps  can  not  long  retain  the  respect  of  the  public,  nor  the  good-will  and 
assistance  of  the  legislators. 

Going  back  some  years,  we  witness  the  birth  of  still  another  medico- 
political  organization.  The  old  herb-  and  steam-doctors,  some  of  whom 
had  picked  up  a  smattering  of  medical  knowledge,  began  to  form  voluntary 
organizations  for  mutual  protection.  Before  long,  they  too  aspired  to  cor- 
porate powers  and  governmental  recognition.  The  _  existing  feud  in  the 
profession  rendered  this  a  comparatively  easy  matter.  Under  the  title  of 
" Eclectics"  they  secured  the  same  chartered  rights  as  the  other  societies. 
There  is  little  doubt  that  at  this  time  the  homoeopaths  aided  the  eclectics, 
believing  that,  by  forming  an  alliance  with  them,  they  could  prevent  the 
regulars  from  in  any  way  curtailing  the  corporate  powers  of  either  body. 
For  obvious  reasons  an  alliance  of  this  sort  could  not  be  very  long  main- 
tained. The  homcBopaths,  as  a  rule,  were  educated  men,  while  the  vast 
majority  of  the  eclectics  were  not.  There  was,  however,  another  cause  that 
tended  to  isolate  the  eclectics  from  the  educated  profession,  and  this  was 
their  code  of  ethics.  Following  the  example  of  the  regulars,  the  homoeo- 
paths adopted  a  code  that  was  a  verbatim  copy  of  the  American  code,  with 
the  single  exception  of  the  consultation  clause.  The  eclectics,  however, 
adopted  a  code  which  in  every  important  respect  was  the  exact  reverse  of 
the  American  code.  In  their  code  they  stated  that  it  was  proper  for  medi- 
cal men  to  hold  patents  on  surgical  instruments,  to  advertise  in  the  papers, 
to  invite  laymen  to  operations,  to  practice  with  secret  nostrums,  etc.  Such 
practices  most  medical  men  regard  as  eminently  improper,  but  this  did  not 
alter  the  fact  that  these  men  were  in  the  eye  of  the  law  fully  as  regular  as 
the  very  elect.  This  position  they  never  would  have  obtained  had  it  not 
been  for  the  existing  feud  between  the  regulars  and  the  homoeopaths. 

We  now  had  in  the  State  of  New  York  three  medico-political  bodies, 
each  with  co-ordinate  powers  and  co-ordinate  jurisdiction.  The  differences 
between  them  were  essentially  as  follows :  The  first  or  older  organization 
and  the  second  one  were  at  variance  simply  on  the  question  of  practical 
therapeutics,  while  on  questions  of  general  medical  polity  they  thought 
alike.  The  third  organization  differed  from  the  others,  both  on  the  ques- 
tion of  therapeutics  and  medical  polity.  One  might  suppose  that  the  State 
of  New  York  was  by  this  time  sufficiently  afflicted,  but  such  was  not  the 


3  THE  STATUS   OF  THE  MEDICAL  PROFESSION      ^ 

case.  A  few  years  later,  still  another  body,  claiming  to  possess  certain 
special  therapeutic  advantages,  obtained  corporate  privileges  and  govern- 
mental recognition.  But  this  was  not  all ;  the  repeal  of  the  penal  clause  of 
the  act  of  1827  permitted  quacks  and  charlatans  of  every  kind  to  come  ta 
the  State  and  deceive  the  unwary  in  any  manner  that  they  chose.  Such 
was  the  condition  of  affairs  up  to  1874.  At  this  time  some  one — I  have 
never  been  able  to  ascertain  who — introduced  into  the  Legislature  a  bill  ta 
regulate  the  practice  of  medicine  in  this  State.  This  bill  would  appear  on 
its  surface  to  have  been  a  desirable  measure,  but  a  careful  study  of  it  ought, 
at  the  time,  to  have  revealed  its  true  inwardness.  If  this  bill  was  not  origi- 
nally drawn  by  the  eclectics,  it  was  unquestionably  manipulated  by  them 
during  its  passage  tkrough  the  Legislature,  and  practically  it  turned  over 
to  them  the  licensing  of  every  quack  in  the  State  who  thought  it  worth 
while  to  pay  them  an  examination  fee  of  ten  dollars.  The  majority  of 
them,  however,  did  not  take  even  this  trouble.  They  had  enjoyed  immu- 
nity for  thirty  years,  and  were  not  afraid  to  take  the  risks  a  little  longer. 
As  a  matter  of  fact,  the  few  prosecutions  that  were  undertaken  came  to  a 
lame  and  impotent  conclusion. 

This,  then,  was  the  state  of  medical  affairs  in  New  York  about  the  year 
1876.  There  were,  first,  the  regular  profession,  enjoying  chartered  rights 
that  dated  back  for  seventy  years,  and  consisting  of  men  who  were  gradu- 
ates in  medicine,  or  licentiates  (after  examination)  of  the  county  societies; 
second,  a  sectarian  offshoot  from  them,  who  were  likewise  educated  men ; 
third,  a  sect  growing  up  by  itself,  and  slipping  into  corporate  existence 
while  the  first  and  second  were  quarreling — an  exceedingly  small  number 
of  these  men  had  received  a  medical  education  ;  fourth,  a  sect  that  died 
almost  at  its  birth ;  and,  fifth,  the  horde  of  miscellaneous  quacks  who  set- 
tled in  the  State  during  the  times  when  this  could  be  done  with  impunity. 
All  of  these  things  were  brought  about  during  the  period  that  the  profes- 
sion were'under  the  guidance  of  the  code  of  ethics  of  the  American  Medi- 
cal Association.  Surely,  if  the  object  of  this  code  were  the  suppression  of 
quackery,  its  success  can  hardly  be  described  as  brilliant.  How  it  is  in 
other  States,  the  profession  there  resident  are  the  best  judges.  In  what 
precedes  and  follows,  I  am  speaking  only  concerning  the  State  of  New 
York.  With  quackery  rampant  to  a  degree  never  before  witnessed  in  this 
locality,  the  problem  to  be  solved  was,  What  were  the  causes  and  what  was 
the  remedy  ?  Th.ese  questions  could  certainly  not  be  answered  off-hand 
and  without  consideration.  The  problem  was  one  that  required  careful  and 
earnest  study,  if  a  correct  solution  was  to  be  reached.  This  study  was  un- 
dertaken by  the  then  officers  and  censors  of  the  Medical  Society  of  the 
County  of  New  York,  whom  the  law  had  constituted  the  guardians  and 
protectors  of  professional  honor  and  professional  interests  within  their  juris- 
diction. Almost  the  first  conclusion  at  which  this  body  arrived  was,  that 
the  laws  regulating  the  practice  of  medicine  were  palpably  defective.  With 
practically  no  law  from  1844  to  1874,  and  after  that  a  worse  than  no  law,  it 


IN   THE  STATE  OF  NEW  YOliK.  g 

was  clear  that,  until  an  efficient  statute  was  enacted,  it  would  be  impossible 
to  expect  much,  if  any,  improvement  in  the  affairs  of  the  profession.  At 
this  juncture  a  gentleman  who  had  acted  as  the  legal  adviser  of  the  society 
offered  to  prepare  a  suitable  bill,  and  endeavor  to  procure  its  enactment. 
His  offer  was  accepted.  A  bill  was  prepared,  and  introduced  in  the  Senate. 
This  bill  was  referred  to  a  committee,  and  an  hour  was  assigned  for  its  con- 
sideration. At  the  appointed  time  the  advocates  and  opponents  of  the  bill 
presented  their  views  to  the  committee,  which  was  represented  solely  by  its 
chairman,  Dr.  Ray  V.  Pierce,  of  Buffalo,  a  noted  medical  advertiser,  and  a 
member,  we  believe,  of  the  eclectic  organization.  The  bill  did  not  meet 
the  approbation  of  the  committee,  was  not  reported  favorably  to  the  Senate, 
and  did  not  become  a  law.  The  next  attempt  to  secure  suitable  medical 
legislation  was  made  by  the  State  Medical  Society.  In  1880  it  instructed  ^ 
its  Committee  on  Legislation  to  prepare  a  proper  law  and  submit  it  to  the 
Legislature.  This  was  done,  and  the  Medical  Act  of  1880  was  the  result. 
Prior  to  the  passage  of  this  act  there  were  in  the  State  upward  of  one  hun- 
dred and  fifty  bodies  that  were  competent  to  legitimize  practitioners  of 
medicine.  The  act  in  question  reduced  the  number  to  thirteen.  Of  these 
bodies,  two  were  eclectic,  two  wete  homoeopathic,  one  was  nondescript,  and 
the  rest  pertained  to  the  regular  school.  Within  the  past  year  two  of  these 
bodies  have  been  declared  illegally  constituted,  and  their  career  has  ended. 
In  1882  an  attempt  was  made  by  the  State  society  to  reduce  the  number 
of  licensing  bodies  to  one.  The  bill  which  was  drawn  for  the  purpose  of 
effecting  this  object  did  not  become  a  law.  The  law  of  1880  remains  in 
force,  and  under  it  the  entire  responsibility  in  regard  to  the  licensing  and 
legalizing  of  practitioners  in  the  State  rests  with  the  medical  colleges  of  the 
State,  while  prosecutions  for  violation  of  the  law  may  be  undertaken  either 
by  individuals  or  the  county  societies.  In  New  York  County  these  prose- 
cutions have  been  numerous,  and  usually  successful.  Thus  far  but  one  flaw 
or  serious  imperfection  in  the  law  has  been  discovered — namely,  that  the 
penalty  for  perjury  in  connection  with  registration  is  not  sufficiently  severe. 
Shortly  after  its  adoption,  our  Pennsylvania  brethren  procured  the  enact- 
ment in  that  State  of  a  law  identical  in  its  main  features  with  the  New 
York  law.  That  the  New  York  law  is  all  that  is  to  be  desired,  or  that  it  is 
the  best  medical  act  in  this  country,  is  far  from  being  claimed.  In  fact,  I 
believe  that  Illinois  and  North  Carolina  have  better  ones,  both  from  a  theo- 
retical and  practical  standpoint. 

From  this  resume  of  the  medico-political  situation  it  will  be  seen  that, 
after  a  sharp  fight  with  quackery,  the  profession  obtained  the  upper  hand 
in  1827  :  that  for  several  years  it  retained  this  control ;  that  in  1844  it  lost 
its  power,  and  failed  to  regain  any  of  it  until  1880 ;  that  even  now  it  does 
not  possess  the  full  powers  and  privileges  that  it  formerly  enjoyed. 


IQ  THE  STATUS   OF  THE  MEDICAL  PROFESSION 


SECOND   AETICLE.^ 

From  the  Nao  York  Medical  Journal  for  April  28, 1883. 

In  our  last  we  presented  the  medico-political  or  legal  relations  of  the 
profession.     In  this  we  will  consider  the  medico-educational. 

The  oldest  of  the  existing  medical  colleges  is  the  College  of  Physicians 
and  Surgeons.  This  institution  was  chartered,  not  directly  by  the  State, 
but  by  the  regents  of  the  university,  in  the  year  1807.  It  was  at  that  time 
virtually  the  same  corporation  as  the  New  York  County  Society,  or,  in 
other  words,  the  county  society  was  constituted  a  medical  faculty,  with  au- 
thority to  teach  and  grant  diplomas.  The  intimate  relationship  was  not 
long  maintained.  The  teaching  body  obtained  independent  powers,  and 
was  subservient,  to  a  slight  degree  only,  to  the  county  society  as  such. 
The  relationship,  however,  was  not  wholly  dissolved,  for,  a  few  years  later, 
when  the  college  exhibited  an  unbecoming  laxity  in  the  granting  of  de- 
grees, the  society  exercised  its  powers  and  influence  to  break  up  these 
practices.  Since  that  time  there  has  been,  so  far  as  we  are  aware,  no  spe- 
cial scandal  connected  with  the  management  of  its  affairs.  As  an  alumnus 
of  the  institution,  we  feel  pride  in  stating  that  it  has,  before  all  others,  been 
careful  in  the  exercise  of  its  corporate  powers.  This  statement,  however, 
is  not  true  of  some  other  colleges  that  were  in  existence  during  the  early 
part  of  this  century.  The  granting  of  diplomas  was  so  lax  that  the  State 
declared  they  should  no  longer  be  a  license  to  practice  ["  The  degree  of 
doctor  of  medicine  conferred  by  any  college  in  this  State  shall  not  be  a 
license  to  practice  physic  or  surgery,"  Act  of  1827,  Sec.  21].  Subsequent 
to  this  time  several  new  colleges  were  organized,  which,  in  their  charters, 
obtained  the  right  to  make  their  diplomas  licenses  to  practice.  At  the 
present  time  the  diploma  of  every  legally  incorporated  medical  college  in 
the  State  carries  with  it  the  license  to  practice.  On  the  other  hand,  no 
medical  college  in  this  country  or  elsewhere  issues  a  diploma  which  entitles 
its  bearer  to  practice  in  this  State,  except  with  the  approbation  of  one  of 
the  college  faculties  of  this  State.  It  matters  not  whether  the  candidate  has 
drawn  his  inspiration  from  Gross  or  Buchanan,  he  must  first  satisfy  a  college 
faculty  of  this  State  of  his  fitness  to  practice  before  he  can  become  a  legally 
quaUfied  practitioner  in  this  State.  As  before  noted,  the  entire  responsi- 
bility concerning  the  qualifications  of  practitioners  coming  into  the  State 


IN  THE  STATE  OF  NEW   YORK.  W 

from  without  the  State  rests  with  the  colleges.     For  the  assumption  of  this 
responsibility  they  are  entitled  to  exact  a  fee  of  twenty  dollars  in  each  case. 

Until  recently  there  were  thirteen  colleges  capable  of  exercising  these 
powers.  Of  these,  eight  professed  to  teach  non-sectarian  medicine,  located, 
four  in  New  York  city,  one  in  Albany,  one  in  Syracuse,  one  in  Buffalo,  and 
one  in  Brooklyn.  Two  taught  homoeopathy,  both  located  in  New  York ;  two 
were  of  the  eclectic  persuasion,  both  in  New  York ;  and  one,  the  "  College 
of  Physicians  and  Surgeons "  of  Buffalo,  was  a  nondescript.  These  col- 
leges all  possess  the  power  of  granting  the  degree  of  doctor  of  medicine, 
and  their  diploma  carries  with  it  the  license  to  practice  in  the  State,  after 
the  graduate  shall  have  complied  with  the  registration  law  of  1880.  The 
legal  requirements  for  graduation  are  the  same  in  all — namely,  three  years' 
pupilage  with  a  legally  qualified  practitioner  (not  necessarily  of  this  State), 
attendance  on  two  full  courses  of  lectures,  the  last  of  which  in  the  college 
granting  the  degree,  and  the  passage  of  a  satisfactory  examination  in  the 
seven  principal  branches  of  medical  science.  It  is  safe  to  say  that  the  re- 
quirements in  the  matter  of  examination  have  not  been  identical  in  the 
thirteen  institutions.  As  regards  the  regular  colleges,  there  have  been  no 
public  scandals  connected  with  improper  graduation  of  candidates,  at  least 
of  late  years.  The  same  can  be  said  of  the  homoeopathic  colleges,  but  can 
not  be  said  of  either  of  the  eclectic  colleges.  The  "  Eclectic  Medical  Col- 
lege "  of  New  York  has  been  very  strongly  suspected  of  issuing  diplomas 
contrary  to  law.  Suspicion  was  first  directed  toward  the  other  eclectic  in- 
stitution, known  as  "  The  United  States  Medical  College,"  in  consequence 
of  the  receipt  by  the  officers  of  the  New  York  County  Society  of  a  com- 
munication from  the  Illinois  authorities  asking  the  status  of  said  college. 
The  communication  further  stated  that  a  person  armed  with  a  diploma  of 
that  institution  had  applied  for  a  license  to  practice  in  Illinois,  under  cir- 
cumstances that  led  them  to  suspect  that  he  had  obtained  his  diploma  ille- 
gally. This  led  the  officers  of  the  society  to  watch  the  college,  and,  on 
examination,  they  became  satisfied  that  the  college  itself  was  not  legally 
incorporated,  and  they  instituted  a  suit  against  it.  The  Supreme  Court  of 
the  State  has,  within  the  past  few  weeks,  rendered  a  decision  to  the  effect 
that  the  college  was  not  legally  incorporated,  and  hence  that  none  of  its 
diplomas  are  legal.  In  Erie  County  the  same  may  be  said.  The  College 
of  Physicians  and  Surgeons  of  Buffalo  stood  on  exactly  the  same  footing  as 
the  United  States  College,  and  a  similar  suit  against  them  has  resulted  in  a 
similar  decision  from  the  Supreme  Court.  We  have  now  but  eleven  medi- 
cal colleges,  against  thirteen  of  a  year  ago.  How  much  further  the  shrink- 
ing process  will  extend  it  is  impossible  to  foresee.  "  The  mills  of  God 
grind  slowly,  yet  they  grind  exceeding  small,"  and  the  profession  of  this 
county  may  rest  assured  that,  if  they  give  their  officers  proper  moral  and 
financial  support,  illegal  pr'actice  and  quackery  of  all  sorts  will  be  an  ex- 
ceedingly haizardous  pursuit. 

^  It  may,  we  think,  be  truthfully  stated  that,  at  the  present  time,  quack- 


;J2  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

ery  *  and  unqualified  practice  prevail  liere  to  a  less  extent  than  in  any  other 
State  in  the  Union,  with  the  exception  of  the  States  of  Illinois  and  North 
Carolina.  On  the  other  hand,  the  States  in  which  it  flourishes  most  lux- 
uriantly are  Massachusetts  and  Pennsylvania,  the  latter  State  claiming  to 
be  the  banner  State  of  the  old  code,  while  the  former  has  a  special  code  of 
its  own  that  is,  in  some  respects,  even  more  stringent  than  that  of  the 
American  Medical  Association.  If  we  turn  now  to  the  States  of  Illinois 
and  North  Carolina  we  find  that  in  the  former  quackery  flourished  to  an 
alarming  extent  just  so  long  as  the  profession  was  actively  aggressive  to- 
ward sectarian  medicine.  As  soon,  however,  as  it  joined  hands  with  sec- 
tarianism for  the  purpose  of  putting  down  quackery,  it  then  began  to  tri- 
umph over  the  common  enemy.  This  joining  of  hands  occurred  when  the 
Illinois  State  Board  of  Health  was  established,  in  which  were  representa- 
tives of  the  regular,  the  homoeopathic,  and  the  eclectic  schools.  In  North 
Carolina  the  case  was  somewhat  different.  In  that  State  the  profession  had 
never  allowed  the  subject  of  sectarianism  to  trouble  them  very  much.  If  a 
homoeopath  by  sia.j  chance  settled  among  them,  they  very  sensibly  let  him 
alone.  They  neither  persecuted  nor  prosecuted  him.  They  gave  him  no 
opportunity  to  play  the  martyr,  or  to  parade  his  grievances  in  public.  We 
have  been  curious  to  learn  the  outcome  of  this  policy,  and,  on  inquiry,  have 
been  informed  that,  of  fourteen  hundred  physicians  in  that  State,  there  are 
but  six  homoeopaths,  and,  so  far  as  known,  no  eclectics.  In  contrast  to 
this  let  us  cite  the  neighboring  county  of  Kings  in  our  own  State.  Many 
years  ago  a  gentleman  of  homoeopathic  proclivities  applied  for  admission 
into  the  county  society.  He  was  refused  membership.  He  carried  the 
matter  to  the  courts,  and  obtained  a  decision  in  his  favor.  He  did  not  join 
the  Kings  County  Society,  however,  as  in  the  mean  time  a  homoeopathic 
society  had  been  formed  of  which  he  became  a  member.  By  the  continu- 
ance of  the  same  policy  the  Kings  County  regulars  succeeded  in  building 
up  against  themselves  a  pretty  strong  sectarian  organization,  and  now  re- 
joice in  one  homoeopath  to  about  every  six  regulars,  a  larger  proportion  of 
homoeopaths  than  will  be  found,  we  believe,  in  any  other  portion  of  the 
United  States.  New  York  city  has  about  one  homoeopath  to  ten  regulars. 
This  digression  aside,  we  return  to  the  subject  immediately  under  con- 
sideration, namely,  the  medico-educational  status  of  this  State.  Of  the 
eleven  medical  colleges,  three  may  be  placed  in  the  front  rank  as  regards 
importance  and  facilities  for  medical  instruction.  Banking  with  them  are 
two  colleges  in  Pennsylvania  and  one  in  Massachusetts.  These  six  colleges 
compete  for  and  obtain  the  patronage  of  the  better  class  of  students,  the 
one  in  Massachusetts,  however,  possessing  a  higher  standard  for  entrance 
than  the  others.  One  of  the  colleges  of  this  State  emulated  the  example  of 
Harvard,  and  declared  that  it  would  require  an  examination  of  the  student's, 

*  Bj'  quackery  we  here  mean  the  practice  of  medicine  by  uneducated  and  legally  un- 
qualified persons  ;  while  by  sectarian  medicine,  practice  in  accordance  with  some  special 
method  or  doctrine. 


/A    THE  STATE   OF  NEW   YORK.  \^ 

fitness  before  permitting  him  to  matriculate.  This  declaration  was  regarded 
by  the  profession  at  large  as  an  indication  that  the  faculty  of  the  college 
were  determined  to  elevate  the  standard  of  medical  education  in  the  State, 
.and  in  thi^  way  contribute  to  the  elevation  and  maintain  the  dignity  and 
honor  of  the  profession.  We  all  know  how  the  experiment  terminated. 
After  one  year's  trial  the  faculty  reconsidered  its  resolution  to  require  a 
preliminary  examination,  and  resumed  its  former  status.  The  two  other 
colleges,  however,  have  made  some  substantial  advances  ;  one  of  them,  by 
enlarging  its  building,  adding  laboratories,  etc,  has  increased  its  facilities 
for  teaching,  and  the  other  has  materially  lengthened  its  lecture  course. 
At  the  present  time  the  clinical  advantages,  the  facilities  for  instruction, 
and  the  quality  of  instruction  actually  given  in  this  city,  are,  we  believe, 
unsurpassed  by  any  to  be  found  elsewhere  in  this  country.  The  other  col- 
leges in  the  State  have,  according  to  their  opportunities,  done  well,  and,  in 
some  respects,  have  shown  a  more  progressive  spirit  than  the  metropolitan 
institutions. 

This,  then,  is  the  medico-educational  status  at  present.  What  it  will  be 
in  the  future  it  is  impossible  to  foresee.  There  are  evidences,  however, 
that  thoughtful  minds  in  the  profession  are  looking  and  hoping  for  still 
greater  improvement.  This  may  take  the  shape  of  a  single  board  of  exam- 
iners, or  the  establishment  of  a  medical  college  so  largely  endowed  that  the 
number  of  the  students  and  of  graduates  will  not  be  a  material  factor  in  the 
requiremeuts  of  the  college,  or  possibly  the  State  or  the  municipality  may 
itself  assume  the  prerogative,  as  in  several  European  countries,  of  educating 
those  who  aspire  to  be  physicians.  These,  however,  are  questions  that  do 
not  appear  to  exact  immediate  settlement,  nor  is  such  settlement  at  present 
possible. 


14:  THE  STATUS   OF  THE  MEDICAL  PROFESSION 


THIRD   ARTICLE. 

From  the  Xew  Yorl-  2Iedical  Journal  for  May  5,  1883. 

Having  considered  briefly,  but  we  believe  accurately,  the  medico- 
political  and  medico-educational  status  of  tlie  profession  in  this  State,  we 
will  now  take  up  tbe  question  of  its  medico-etMcal  position  and  require- 
ments. 

As  already  noted,  tbe  earliest  attempt  at  etbical  regulation  in  tbis  State 
was  tbe  adoption  of  tbe  System  of  Ethics  of  tbe  Medical  Society  of  the 
State  of  New  Tort  in  the  year  1823,  long  before  any  other  State  had 
thought  it  worth  while  to  move  in  tbe  matter.  This  code  remained  in 
force  until  1880.  About  the  year  1850  the  "  Code"  of  the  American  Medi- 
cal Association  was  also  adopted  by  the  State  society,  but  without  tbe 
repeal  of  the  older  code.  The  profession  of  the  State  were,  therefore, 
under  tbe  guidance  and  governance  of  two  distinct  codes,  the  respective 
provisions  of  which  were  not  altogether  in  harmony.  Thirty-five  years  ago 
there  were  those  who  preferred  the  old  State  "  System"  to  the  "Code"  of 
tbe  American  Medical  Association ;  but,  as  by  the  adoption  of  the  Ameri- 
can Medical  Association  code  there  was  a  prospect  of  national  unity  on  . 
tbe  matter,  they  yielded  their  preferences,  and  consented  to  be  bound  by 
both,  thus  accepting  a  measure  of  etbical  responsibility  in  excess  of  that 
borne  by  the  profession  in  any  other  State  in  the  TTnion.  At  this  time 
there  was  no  other  organized  section  of  tbe  profession  to  question  tbe  pro- 
priety of  tbis  code,  or  to  propose  the  adoption  of  another.  A  few  years- 
later  tbe  homoeopaths  became  organized,  and  acquired  chartered  privileges. 
They  were,  as  already  stated,  an  outcropping  from  tbe  general  profession, 
and  thought  best  to  follow  its  example  and  adopt  a  code.  This  code  was 
an  almost  exact  transcript  of  the  American  code,  with  the  exception  of  tbe 
paragraph  relating  to  tbe  question  of  consultations.  On  tbis  point  they 
differed  from  tbe  older  code  as  foUows : 

"  A  complete  medical  education,  of  which  the  diploma  of  a  medical 
college  is  the  formal  voucher,  furnishes  tbe  only  presumptive  evidence  of 
professional  acquirements  and  abilities.  But  tbe  annals  of  the  profession 
contain  the  names  of  some  who,  not  having  the  advantages  of  a  complete 
medical  education,  became,  nevertheless,  through  their  own  exertions  and 
abilities,  brilliant  scholars  and  successful   practitioners.     A   practitioner,. 


IN  THE  STATE   OF  NEW   YORK.  \^ 

therefore,  whatever  his  credentials  may  be,  who  enjoys  a  good  moral  and 
professional  standing  in  the  community,  should  not  be  excluded  from  fel- 
lowship, nor  his  aid  rejected,  when  it  is  desired  by  the  patient  in  consul- 
tation. No  difference  in  views  on  subjects  of  medical  principles  or  prac- 
tice should  be  allowed  to  influence  a  physician  against  consenting  to  a 
consultation  with  a  fellow-practitioner.  The  very  object  of  a  consultation 
is  to  bring  together  those  who  may,  perhaps,  differ  in  their  views  of  the 
disease  and  its  appropriate  treatment,  in  the  hope  that,  from  a  comparison 
of  different  views,  may  be  derived  a  just  estimate  of  the  disease  and  a  suc- 
cessful course  of  treatment. 

"  No  test  of  orthodoxy  should  be  applied  to  limit  the  freedom  of  con- 
sultations. Medicine  is  a  progressive  science.  Its  history  shows  that  what 
is  heresy  in  one  century  may,  and  probably  will,  be  orthodoxy  in  the  next. 
No  greater  misfortune  can  befall  the  medical  profession  than  the  action  of 
an  [influential  association  or  academy  establishing  a  creed  or  standard  of 
orthodoxy  or  regularity.  It  will  be  fatal  to  freedom  and  progress  in  opinion 
and  practice.  On  the  other  hand,  nothing  will  so  stimulate  the  healthy 
growth  of  the  profession,  both  in  scientific  strength  and  in  the  estimation 
of  the  public,  as  the  universal  and  sincere  adoption  of  a  platform  Avhich 
shall  recognize  and  guarantee  : 

"1.  A  truly  fraternal  good-will  and  fellowship  among  all  who  devote 
themselves  to  the  care  of  the  sick. 

"  2.  A  thorough  and  complete  knowledge,  however  obtained,  of  all  the 
direct  and  collateral  branches  of  medical  science,  as  it  exists  in  all  sects  and 
schools  of  medicine — as  the  essential  qualifications  of  a  physician. 

"  8.  Perfect  freedom  of  opinion  and  practice,  as  the  prerogative  of  the 
practitioner,  who  is  the  sole  judge  of  what  is  the  best  mode  of  treatment  in 
each  case  of  sickness  intrusted  to  his  care." 

The  additional  sections  of  the  homoeopathic  code  so  closely  resemble 
those  of  the  American  code  that  they  need  not  be  quoted.  They  recognize 
the  impropriety  of  advertising,  of  patenting  surgical  instruments,  of  prac- 
ticing with  nostrums,  keeping  secret  the  nature  and  composition  of  medi- 
cines used,  etc. 

A  few  years  later,  when  the  eclectics  became  organized,  they  also 
adopted  a  code — one  that  was  likewise  based  on  the  American  code,  and 
differing  from  it  mainly  by  reversing  the  intent  of  many  of  the  most  im- 
portant sections  of  the  older  code  as  follows  : 

"Article  III  (^Eclectic   Code). 

"  Medical  men  have  an  undoubted  right  to  bring  themselves  and  their 
claims  before  the  public  by  every  fair  and  honorable  means,  as  much  as 
any  other  class  of  men.  They  may  enter  into  general  or  special  practice 
as  they  may  consider  best  adapted  to  their  interests  or  to  their  peculiar 
views ;  they  may  introduce  themselves  to  the  notice  of  the  public  by  printed 
cards  or  other  publications,  by  public  or  private  lectures,  or  by  the  publica- 


1(3  TEE  STATUS   OF  THE  MEDICAL  PROFESSION' 

tion  of  certificates  of  cures  actually  performed.  Tlie  presence  of  laymen 
at  operations  is  by  no  means  objectionable  if  botb  patient  and  operator 
sliall  consent,  as  it  tends  to  make  the  skill  and  ability  of  tbe  operator  bet- 
ter known  in  the  community,  etc. 

"  Article  Y. 

"  A  medical  man  having  invented  any  surgical  instrument,  or  discovered  ' 
any  new  or  valuable  medicine,  it  becomes  his  capital,  and  it  is  not  unpro- 
fessional for  him  to  obtain  a  patent  for  the  same.  ...  A  physician  may 
employ,  in  his  ovrn  practice,,  a  medicine  or  compound  known  only  to  him- 
self ;  it  is  his  capital,  and  there  is  no  authority  in  the  land  ■which  can  com- 
pel him  to  divide  that  capital  among  others  by  disclosing  his  remedy,  save 
his  own  benevolence  and  philanthropy,"  etc. 

Such  is  the  "  Code  "  of  a  body  of  men  who  would  never  have  received 
governmental  recognition  if  the  educated  members  of  the  profession  had  not 
been  engaging  in  a  bitter  internecine  warfare. 

This  was  the  status  of  nominal  etbics  untU  within  a  recent  period.  The 
regular  profession  and  the  two  sectarian  bodies  each  had  its  code  of  ethics, 
differing  from  the  others  in  the  manner  that  we  have  seen.  Wbile  the 
American  code  held  sway  over  the  great  mass  of  the  profession,  sectarianism 
was  increasing  in  power  and  influence.  An  evil  which  at  its  birth  could 
have  been  easUy  controlled  by  wise  measures  was,  on  the  other  hand,  inju- 
diciously stimulated  to  an  abnormal  growth.  For  many  years  tbe  American 
code  had,  in  great  measure,  lost  its  vitality,  and  its  edicts  were  not  re- 
spected. One  form  of  impropriety  after  another  came  to  the  surface,  which, 
it  appeared  unable  to  rectify  or  control.  Eminent  members  of  the  profes- 
sion began  to  violate  not  only  its  spirit,  but  its  letter,  and  the  corporate 
bodies  of  which  they  were  members  appeared  unwilling  or  unable  to  sub- 
ject them  to  discipline.  About  fifteen  years  ago  the  Xew  York  Academy 
of  Medicine  did  discipline  one  of  its  members  for  consulting  with  a  homoeo- 
path. Their  experience  on  that  occasion  led  them,  quite  wisely,  to  refrain 
from  a  repetition  of  the  experiment.  A  few  more  such  attempts  would  un- 
doubtedly have  led  to  the  disruption  of  the  Academy,  and,  in  all  proba- 
bility, to  a  forfeiture  of  its  corporate  privileges.  The  suspension  of  the  late 
Dr.  Gardner  from  his  rights  as  a  Fellow  of  the  Academy  undoubtedly  acted 
as  a  partial  restraint  on  the  other  members  of  that  body,  and  more  especially 
on  those  who  were  comparatively  young  in  the  profession,  or  without  suf- 
ficient influence  to  shield  them  from  prosecution.  As  a  matter  of  fact,  two 
Fellows  of  the  Academy  permitted  it  to  be  publicly  understood  that  they 
consulted  with  homoeopaths,  and  would  continue  to  do  so  as  often  as  they 
pleased.  Despite  this  fact,  these  members  have  never  been  brought  to  the 
bar  of  the  Academy  for  discipline. 

In  1865  ethical  affairs  were  in  such  a  state  in  Xew  York  that  the  late 
Dr.  Oliver  White  saw  fit  to  send  to  the  Comitia  Minora  of  the  county  so- 
ciety a  communication,  from  which  I  extract  the  following  :  "  It  is  patent  to 


IN  THE  STATE  OF  NEW    YORE.  J  7 

Hs  all,  Mr.  Chairman,  and  it  is  daily  manifest,  that  members  of  our  profes- 
sion, once  occupying  honorable  positions  in  it,  have  lost  their  standing 
among  us  by  their  own  disreputable,  dishonorable,  and  empirical  practices, 
in  violation  of  all  medical  ethics  ;  and,  insomuch  as  we  are  not  permitted 
by  the  laws  of  the  State  to  discipline  or  expel  unworthy  members  from  the 
county  medical  societies^  except  through  the  courts ;  and,  insomuch  as  we 
deem  it  both  just  and  proper  that  our  county  society  should  be  the  custo- 
dian of  its  own  honor,  and  the  conservator  of  its  own  morals — therefore  do 
I  earnestly  entreat  the  Comitia  Minora  to  draft  a  memorial  to  the  Legisla- 
ture of  the  State,  praying  that  honorable  body  to  grant  the  county  medical 
societies  throughout  the  State  relief  from  the  oppressive  disabilities  afore- 
mentioned; and  that  the  Comitia  ask  the  approval  of  the  society  to  the 
proposed  action  in  this  matter." 

The  result  of  this  action  was  the  passage  of  the  Medical  Act  of  1866, 
which  gave  the  county  societies  almost  plenary  powers  in  matters  of  disci- 
pline. At  the  meeting  of  the  county  society,  held  June  4, 1866,  a  resolution 
was  offered  to  the  effect  "  that  a  committee  of  three  be  appointed  to  examine 
our  list  of  members,  and  report  the  names  of  those  whose  connection  wiLh 
the  society  should  be  dissolved,  and  also  what  steps  should  be  taken  to  ac- 
complish this  result."  This  resolution  was  referred,  with  others,  to  a  com- 
mittee of  five,  which  met  and  considered  the  matters  referred  to  them. 
This  latter  committee  reported  at  the  September  meeting  of  the  society  that 
they  could  not  purge  the  roll  of  membership  as  proposed,  and  recom- 
mended that  "  no  further  action  be  taken  upon  the  matter  at  present,"  and 
requested  "  to  be  excused  from  further  deliberation."  This  was  certainly  a 
rather  impotent  conclusion  of  the  effort  to  purify  the  morals  of  the  profes- 
sion. Since  then  very  little  has  been  done  iu  the  way  of  attempting  to 
check  violations  of  the  code. 

This  brings  us  to  the  year  1876,  when  the  first  open  and  bold  proposal 
to  repeal  this  code  was  made  by  Dr.  J.  Marion  Sims,  in  his  presidential 
address  before  the  American  Medical  Association.  From  this  address  we 
extract  the  following  : 

"  Here  common  sense  and  common  interests  have  silently,  almost  im- 
perceptibly, established  a  higher  law  that  overrides  the  code  and  leaves  it 
inert." 

"  The  code  of  ethics  is  violated  every  day,  either  willfully  or  ignorantly, 
not  only  by  the  rank  and  file,  but  by  men  high  in  the  profession — men  who 
are  considered  leaders,  advanced  thinkers,  and  workers." 

The  proposition  of  Dr.  Sims  to  abolish  the  code  produced  a  profound 
sensation.  Many  thoughtful  persons  asked  themselves  whether  the  code  as 
it  existed,  but  unenforced,  was  doing  any  good,  while  others  asked  whether 
or  not  it  was  not  doing  absolute  harm.  It  may  be  safe  to  say  that  by  the 
majority  Dr.  Sims's  proposition  was  looked  on  with  disfavor.  At  all  events, 
no  action  was  taken  in  support  of  it  by  the  association  at  the  time.  This 
is  not  surprising  when  we  consider  the  composition  of  this  body,  ma  de  up 


13  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

as  it  is  of  representatives  from  all  parts  of  the  country,  very  few  of  whom 
had  examined  the  subject  with  any  care.  The  hatred  of  sectarianism  was 
so  great  that  men  seemed  unable  to  calmly  consider  how  it  could  be  abated. 
Nothino-  was  done.  Shortly  after  this  the  writer  found  himself,  as  an  offi- 
cer of  the  county  society,  face  to  face  with  questions  in  ethics  that  must  be 
met.  The  code  was  violated  daily,  both  by  those  of  high  and  low  degree  ; 
but  discipline  was  rarely  asked  for,  except  to  gratify  some  personal  malice. 
The  two  most  obvious  violations  consisted  in  mixed  consultations,  and  a 
striving  after  notoriety  through  the  medium  of  the  public  press.  These 
evils  the  officers  of  the  society  found  themselves  powerless  to  combat.  This 
may  appear  to  be  a  strange  statement,  but  the  facts  are  as  follows :  In  refer- 
ence to  mixed  consultations,  the  apparent  spirit  of  the  code  was  rendered 
nugatory  by  a  change  of  base  on  the  part  of  the  homoeopaths  themselves. 
Their  State  society  adopted  a  formal  resolution,*  in  which  they  declared 
that  for  the  future  they  would  not  adhere  to  the  exclusive  doctrines  of 
Hahnemann,  but  would  use  such  other  methods  as  individually  they  saw  fit. 
A  careful  comparison  of  this  resolution  with  the  consultation  clause  of  the 
code  makes  it  clear  that  the  homoeopaths  had  thus  technically  freed  them- 
selves from  the  ban,  and  that  it  would  be  impossible  to  discipline  a  member 
of  the  county  society  who  should  consult  with  them. 

The  second  difficulty  that  embarrassed  the  Comitia  was  the  matter  of 
newspaper  notoiiety  which  certain  members  gained  through  "  interviews," 
and  through  certificates  given  in  favor  of  certain  mineral  waters,  etc.  This 
was  a  new  form  of  impropriety,  against  which  there  was  no  pro^dsion  in 
the  by-laws  of  the  society,  and  the  Comitia  were,  therefore,  powerless  to 
take  official  cognizance  of  the  matter.  The  president  of  the  society,  how- 
ever, took  on  himself  the  burden  of  appealing  personally  to  the  offending 
members.  Strange  as  it  may  appear,  some  of  them  referred  him  to  the 
code  of  the  American  Medical  Association,  and  claimed  that  their  conduct 
was  not  only  blameless,  but  praiseworthy.  Curiously,  an  examination  of 
this  code  appeared  to  support  their  claim.  Under  these  circumstances,  the 
Comitia  had  but  one  resource — namely,  an  appeal  to  the  State  society,  in 
the  hope  that  it  would  enact  sach  laws  as  would  enable  the  county  societies 
to  effectually  deal  with  the  evils  referred  to.  Such  an  appeal  was  made  to 
the  State  society,  at  its  session  in  1879.     It  was  disregarded,  and  no  relief 

*  Resolved,  Tiat,  in  common  with  other  existing  associations  which  have  for  their 
object  investigations  and  other  labors  which  may  contribute  to  the  promotion  of  medical 
science,  we  hereby  declare  that,  although  firmly  believing  the  principle  similia  similibus 
curantur  to  constitute  the  best  general  guide  in  the  selection  of  remedies,  and  fully  in- 
tending to  carry  out  this  principle  to  the  best  of  our  abihty,  this  beUef  does  not  debar  us 
from  recognizing  and  making  use  of  any  experience,  and  we  shall  exercise  and  defend 
the  inviolable  right  of  every  educated  physician  to  make  practical  use  of  any  estabUshed 
principle  in  medical  science,  or  of  any  therapeutic  facts  founded  on  experiments  and 
verified  by  experience,  so  far  as,  in  his  individual  judgment,  they  shall  tend  to  promote 
the  welfare  of  those  under  his  professional  care." — Adopted  by  the  Homoeopathic  State 
Society,  February,  18Y8. 


IN    THE  STATE  OF  NEW   YORK.  |9 

was  afforded  by  the  State  society.  The  Comitia,  however,  were  not  alto- 
gether discouraged,  and  requested  the  writer  to  correspond  with  the  chair- 
man of  the  proper  committee  of  the  State  society  and  ask  him  to  make  a 
personal  investigation  of  the  matters  in  question.  A  lengthy  correspond- 
ence resulted.  It  was  early  conceded  that  the  American  code  did  not 
afford  protection  against  the  rapidly  increasing  certificate  nuisance,  and,  if 
this  ought  to  be  stopped,  some  new  and  more  effective  rule  must  be  adopted. 
The  matter  of  consultations,  however,  presented  much  greater  diflSculties 
in  the  way  of  settlement,  as  on  it  hinged  the  whole  question  of  sectarian- 
ism and  its  influence  for  good  or  ill  on  the  profession.  The  present  writer's 
views  on  the  subject  were  presented  in  the  form  of  a  letter  under  date  of 
November  28,  1879.     From  this  letter  I  shall  now  quote  at  some  length: 

"  The  question  "  (of  sectarianism)  "  is  a  grave  one,  and  demands  serious 
examination  at  the  hands  of  the  enlightened  members  of  the  profession, 
and  never  more  so  than  at  the  present  time.  The  subject  must  be  looked 
at  in  its  several  aspects,  and  regarded  from  the  standpoints  of  medical  poli- 
tics, of  doctrine,  of  utility,  and  of  its  present  raison  d'etre. 

"■  In  respect  to  the  medico-political  aspect  of  the  question,  it  may  be 
stated  that  the  existence  of  sectarianism  in  medicine  is  a  great  evil,  perhaps 
the  greatest  that  at  present  oppresses  the  profession,  and  tends  to  injure  it 
in  the  esteem  and  respect  of  the  public.  The  State  has  seen  fit  to  recog- 
nize three  kinds  of  practitioners,  who  are  in  the  position  of  public  antago- 
nists, each  claiming  that  the  general  methods  of  treatment  pursued  by 
them  are  superior  to  those  employed  by  the  others,  and  each  decrying  and 
speaking  in  derogatory  terms  of  the  others.  The  public  is  not  competent 
to  decide  to  which  of  these  the  greatest  measure  of  merit  pertains;  and, 
in  the  majority  of  instances,  the  choice  of  a  medical  attendant  is  the  result 
of  considerations  that  need  not  be  entered  into  at  present.  The  public, 
however,  interests  itself  to  a  greater  or  less  degree  in  the  controversial  ele- 
ments of  the  question,  and  the  result  is  a  certain  distrust  of  and  lack  of 
confidence  in  all  three. 

"  The  venerable  Hufeland,  nearly  fifty  years  ago,  in  a  very  able  essay 
on  the  subject,  pointed  out  the  evils  that  would  result  from  sectarianism  in 
medicine,  and  anticipated  the  statement  made  in  the  last  paragraph.  He 
wrote :  '  Nothing  is,  on  the  whole,  more  prejudicial  to  our  art,  nothing 
tends  more  to  diminish  public  confidence  in  it,  than  a  x>ublic  quarrel,  and 
the  public  expression  of  a  mutual  depreciation  of  one  another  by  its  professors. 
All  who  have  the  honor  of  the  art  at  heart  must  lament  such  open  bicker- 
ings, and  do  all  they  can  to  prevent  them.  The  public  is  only  too  disposed 
to  interest  itself  and  to  find  amusement  in  them.  Has  it  not  already  come 
to  such  a  length  that  our  dissensions  are  paraded  on  the  stage,  just  as  in 
the  time  of  Moliere  ?  And  do  we  not  feel  that  just  as  the  estimate  of  our 
art  in  general  decreases,  so  every  one,  to  whatever  party  he  may  belong, 
loses  somewhat  ? '  .  .  . 

"  If,  now,  it  be  granted  that  sectarianism  is  an  evil,  does  it  not  behoove 


20  THE  STATUS    OF  THE  MEDICAL  PROFESSION 

the  profession  to  consult  together  as  to  the  best  means  to  abate  it?  Be- 
fore, however,  this  question  is  answered,  it  will  be  necessary  to  consider 
■whether  the  abatement  of  this  evil  would  bring  about  others  that  were  still 
greater.  The  correct  solution  of  this  necessitates  an  acquaintance  with  a 
large  number  of  facts,  pro  and  con,  which  must  be  duly  weighed,  and  the 
probable  effects  of  any  change  in  the  present  status  carefully  estimated. 
The  opinion  that  I  have  personally  formed  is,  that  a  certain  amount  of  tem- 
porary inconvenience  would  ensue,  to  be  followed  by  advantages  that  would 
more  than  counterbalance  it.  .  .  . 

"  If  the  abolition  of  legalized  sectarianism  is  desirable,  the  methods  of 
its  accomplishment  must  be  considered.  To  this  end  but  two  are  known  to 
me — namely,  force  and  persuasion.  Force  has  been  tried,  and  has  failed  as 
regards  the  homoeopaths.  The  more  severe  the  exclusive  enactments  against 
them,  the  more  they  have  seemed  to  flourish.  The  American  Medical  As- 
sociation, in  ]  847,  by  the  enactment  of  the  consultation  clause  in  the  code, 
thought,  by  thus  throwing  odium  on  them,  that  the  people  would  sustain 
the  profession  and  refuse  to  employ  the  homoeopath.  In  this  the  asso- 
ciation was  mistaken.  .  .  .  The  action  of  the  association,  therefore,  by 
excluding  the  early  homoeopaths  from  professional  intercourse,  simply 
caused  them  to  unite  the  closer  among  themselves,  each  befriending  and  de- 
fending the  other  in  time  of  need,  and  all  uniting  for  the  promotion  of  cer- 
tain common  objects,  more  especially  the  acquisition  of  the  confidence  of 
the  people,  and  the  attainment  of  governmental  recognition.  The  .measure 
of  success  that  has  attended  their  efforts  we  are  all  witnesses  of  to-day.  It 
will,  therefore,  be  readily  granted  that  the  policy  of  the  association  has  not 
accomplished  its  object,  i.  e.,  the  suppression  of  homoeopathy,  and  I  seri- 
ously question  whether  a  continuance  of  this  policy  will  not  prolong  and 
aggravate  the  present  evils. 

"  Before,  however,  any  other  method  be  attempted,  it  is  expedient  that 
we  should  be  accurately  acquainted  with  the  political  and  doctrinal  status 
of  the  homoeopathy,  not  of  1847,  but  of  to-day,  and  we  should  more  par- 
ticularly regard  the  matter  in  its  relations  to  the  people  and  the  profession 
of  the  State  of  New  York.  The  homoeopaths  of  this  State  may  be  divided 
into  two  pretty  sharply  defined  groups.  One  group  holds  that  the  propo- 
sition "similia"  is  of  great  service  in  the  selection  of  drugs  where  these 
agencies  are  requisite  in  the  treatment  of  disease.  They  respect  Hahne- 
mann as  a  prominent  promulgator  of  this  doctrine.  They  reject,  however, 
his  theory  of  dynamization,  they  reject  his  peculiar  views  regarding  the 
origin  of  chronic  diseases,  they  reject  his  views  as  to  dosage,  and  disbelieve 
or  deny  his  statements  concerning  the  eflficacy  of  infinitesimals.*  The 
other  group  of  homoeopaths  pretend  to  hold  strictly  to  all  of  Hahnemann's 

*  "  The  homceopathy  of  to-day  has  also  shaken  fi'om  its  feet  the  dust  of  more  than 
one  worthless  theory.  Although  within  its  ranks  are  still  numbered  some  so-called  high 
dilutionists,  its  leaders  have  long  ceased  to  insist  upon  LnCnitesimal  dosage  as  an  essential 
principle  of  treatment." — Beaed,  "Popular  Science  Monthly,"  February,  1883. 


IN  THE  STATE   OF  NEW   YORK.  21 

doctrines,  and  consider  themselves  his  only  genuine  followers.  An  aggres- 
sive movement  on  the  part  of  this  latter  party  led  the  liberals  to  a  counter- 
movement,  which  resulted  in  the  adoption  by  their  societies  of  the  resolu- 
tion Ave  have  given  above,  and  a  decided  split  in  their  ranks, 

"  The  regular  profession  has  now  an  opportunity  of  settling  the  homoeo- 
pathic difficulty  in  a  very  simple  manner.  Let  it  be  understood  that  it  is 
willing  to  receive  into  fellowship  those  who  have  practically  abandoned 
Hahnemann's  homoeopathy,  on  condition  that  they  also  abandon  the  name, 
calling  themselves,  and  permitting  themselves  to  be  called,  jjhysicians  sim- 
ply. It  is  probable  that  during  the  first  year  or  so  but  a  small  number 
would  avail  themselves  of  the  opportunity  of  joining  the  county  societies. 
Later  they  would  come  in  more  freely.  This  would  result  in  a  return  to 
the  State  of  the  chartered  rights  now  possessed  by  them,  and  the  removal 
of  sectarian  and  offensive  titles  from  the  hospitals,  dispensaries,  colleges, 
and  journals  now  controlled  by  them." 

The  above  are  the  views  that  were  held  by  me  at  the  date  that  the 
above  letter  was  written,  and  are  in  substantial  accord,  with  those  that  I 
hold  to-day. 

There  is  little  doubt  that,  if  this  course  had  been  pursued  at  that  time, 
when  the  homoeopaths  were  in  so  badly  demoralized  a  condition,  to-day 
there  would  have  been  no  organized  body,  in  this  county  at  least,  occupy- 
ing an  antagonistic  attitude.  The  writer's  position  was,  and  is,  that  social 
and  professional  absolution  be  accorded  to  all  who  are  willing  to  renounce 
exclusivism  and  unite  with  the  main  body  of  the  profession. 

In  the  number  of  this  Journal  for  April  7th,  pages  372  and  373,  Dr. 
Flint  would  appear  to  be  willing  to  go  even  further,  and  accord  professional 
recognition  to  all,  whatever  their  belief  or  practice,  provided  only  they  dis- 
continued their  connection  with  sectarian  societies. 


22  THE  STATUS   OF  THE  MEDICAL  FEOFESSIOj^^ 


FOURTH   ARTICLE, 

'From  tlie  Xeic  York  Medical  Journal  for  May  S6, 1883. 

At  the  annual  meeting  of  the  Medical  Society  of  the  County  of  New- 
York,  held  Octoher  25,  1880,  its  Committee  on  Ethics  made  the  following 
report :  * 

..."  Almost  without  an  exception,  therefore,  the  work  of  the  committee 
has  been  confined  to  complaints  against  members  of  the  society  for  public  adver- 
tising, or  methods  that  are  regarded  as  at  variance  with  the  spirit,  if  not  the  let- 
ter, of  that  portion  of  the  American  Code  of  Ethics  embraced  in  Chapter  11^ 
paragraphs  three  and  four. 

"  The  committee  approached  this  well-known  field  of  action,  where  an  almost 
ineflfectaal  skirmish  has  long  been  kept  up,  with  feelings  of  great  uncertainty  as 
to  what  the  result  of  their  efforts  would  be,  and  with  a  desire  to  perform  their 
unpleasant  duty  without  giving  unnecessary  ofi'ense  to  any.  The  committee,  al- 
though to  some  extent  shielded  from  personal  attacks  by  its  official  character^ 
has  been  unable  in  all  instances  to  perform  its  duties  without  censure  from  indi- 
viduals with  whom  it  has  been  in  communication  ;  and  in  other  instances,  where 
requirements  were  made  under  the  committee's  interpretation  of  the  law,  it  has 
encountered  firm  opposition.  Previous  to  this  committee's  appointment,  efforts 
had  been  successful  in  securing  the  withdrawal  of  physicians'  mineral-water  tes- 
timonials from  the  public  press,  hut  it  was  well  known  to  the  committee  that  all 
attempts  to  suppress  those  still  appearing  in  the  medical  journals  had  been  in  the 
main  unavailing :  indeed,  these  futile  efforts  were  treated  as  an  encroachment  on 
the  rights  of  those  concerned. 

"  The  society,  when  appealed  to  on  this  subject  at  a  meeting  held  April  22, 
18T8,  adopted  a  resolution  clearly  expressing  its  disapproval  of  the  practice  of 
giving  certificates  to  be  used  in  bringing  to  notice  '  any  drug,  nostrum,  mineral 
water,  wine,  or  other  proprietary  article  intended  to  be  used  as  a  medicine  or 
remedy  in  disease,  or  to  any  patented  instrument  or  appliance  that  is  intended 
for  medical  or  sui'gical  use.' 

"This  resolution,  which,  morally  at  least,  had  all  the  force  of  a  by-law  of  the 
society,  was  at  the  time  of  its  adoption  brought  to  the  notice  of  every  member 
of  the  society.  The  effect,  however,  was  not  what  had  been  expected,  and  the 
commercial  pages  of  the  medical  press  still  teemed  with  advertisements  of  trade- 
marked  preparations,  etc.,  bearing  the  sanction  of  medical  men.  .  .  . 

"  The  committee,  after  mature  deliberation,  being  encouraged  by  the  success 

*  I  omit  such  portions  of  the  report  as  have  no  bearing  on  the  present  question. 


IN  THE  STATE   OF  NEW   YORK.  23 

others  had  already  attained,  and  fortified  by  the  resolution  of  the  society  above 
alluded  to,  thought  that  it  was  clearly  their  duty  to  make  another  appeal  to  those 
who  stiU  considered  tliat  they  had  a  right  to  give  their  sanction  to  the  articles 
under  consideratiou  ia  a  manner  objectionable  to  the  profession  in  general.  The 
committee,  therefore,  adopted  the  following  at  a  meeting  held  January  7,  1880: 
'•Resolved,  That,  in  view  of  the  fact  that  these  certificates  are  offensive  to  a  ma- 
jority of  the  profession,  and  that  their  continuance  is  an  injury  to  professional 
tone,  the  Committee  on  Ethics  respectfully  requests  the  gentlemen  concerned  to 
take  measures  to  have  them  discontinued.'  This  resolution,  together  with  that 
adopted  by  the  society,  was  printed  in  the  form  of  a  circular,  and  copies  of  it 
were  sent  to  all  whose  names  had  been  reported  to  the  committee,  with  a  request 
that  they  would  signify  to  the  committee  what  course  they  intended  to  pursue  in 
the  matter.  The  total  number  to  whom  the  circular  was  sent  did  not,  perhaps, 
exceed  two  dozen. 

"As  a  result  of  this  action,  a  very  small  number  signified  their  intention  to 
withdraw  the  objectionable  testimonials,  and  the  committee  has  been  informed 
that  they  have  done  so.  In  a  few  instances,  letters  in  vindication  of  certificate 
writing  were  received,  but  it  is  believed  that  the  position  assumed  in  defense  is 
not  tenable,  for  in  the  advertisement  of  lactopeptine,  for  instance,  the  virtues  of 
the  remedy  are  extolled  in  a  manner  rather  to  arrest  the  public  eye  than  instruct 
the  physician;  and  this  of  a  preparation  where  the  method  of  manufacture  is 
kept  secret,  and  where  the  copying  of  its  name  by  any  one  would  render  him 
liable  to  prosecution.  The  indication  of  the  constituents  of  this  preparation 
does  not  relieve  it  from  the  objection  held  against  trade-marked  and  proprietary 
articles. 

"The  greater  number  to  whom  the  circular  was  sent,  however,  failed  to 
respond  to  the  committee's  request,  and  their  certificates  continue  to  appear. 

"It  will  thus  be  seen  that  the  committee  has  advanced  this  work  but  little, 
for,  so  long  as  any  member  can  permit  of  the  publication  of  these  certificates 
with  impunity,  the  majesty  of  the  codes  of  ethics  is  not  maintained.  And,  now 
that  the  society  has  continued  to  experience  defeat  in  this  matter,  it  may  be  well, 
before  entering  the  contest  again,  to  inspect  its  position  and  strength.  The  com- 
mittee has,  therefore,  made  a  careful  examination  of  that  portion  of  the  Ameri- 
can Code  of  Medical  Ethics  and  of  the  System  of  Medical  Ethics  of  the  Medical 
Society  of  the  State  of  New  York  bearing  on  this  subject,  and  it  seems  to  it  that, 
although  their  provisions  may  have  been  sufficient  for  the  time  when  they  were 
adopted,  a  gradual  transformation  in  the  character  of  the  abuses  alluded  to  has 
taken  place,  and,  instead  of  secret  remedies,  there  has  grown  up  the  proprietary 
and  trade-marked  article,  which  requires  the  investment  of  a  large  amount  of 
capital.  Secrecy  has  ostensibly  been  removed  as  to  the  constituents  of  these 
goods,  but  their  manufacture  or  imitation  is  successfully  prevented  by  patents 
and  trade-marks.  That  they  owe  their  chief  value  to  professional  testimonials 
and  skillful  advertising  may  well  be  believed.  The  committee  has  failed  to  find 
anything  in  the  codes  referred  to  sufficiently  explicit  to  give  them  plenary  power 
to  take  further  action.  If,  therefore,  the  society  desires  to  prevent  its  members 
contributing  to  trade  interests  in  the  manner  above  alluded  to,  and  thus  injuring 
its  own,  it  has  ample  power  under  the  State  statutory  laws  to  make  the  resolu- 
tion of  April  22,  1878,  a  by-law  of  the  society.  The  experience  of  the  committee 
leads  it  to  believe  that  no  other  course  will  accomplish  the  end  desired.  .  .  . 

"  In  this  connection,  it  may  be  pardonable  for  the  committee  to  state  that  its 


24  THE  STATUS    OF  THE  MEDICAL  PROFESSION 

experience  during  the  past  year  has,  in  a  forcible  manner,  demonstrated  the  in- 
adequacy of  the  present  codes  of  medical  ethics  to  tlie  existing  demands  of  the 
profession.  The  code  adopted  by  the  American  Medical  Association  thirty  odd 
years  ago  has  in  many  respects  become  obsolete ;  what  were  deemed  offenses 
then  are  no  longer  regarded  in  tlie  same  light.  Per  contra,  the  ingenuity  of  man 
has  developed  practices  which  were  unknown  when  the  codes,  national  and 
State,  were  established,  and  hence  were  unprovided  for.  The  code  of  the  Ameri- 
can Medical  Association  contains  a  mass  of  sentimental  advice  which,  together 
with  its  moral  platitudes  and  verbiage,  would  seem  to  suggest  the  necessity  for 
its  revision.  Our  own  System  of  Medical  Ethics,  which  the  State  society 
adopted  iu  1823,  and  which  has  since  been  subjected  to  but  few  alterations,  is, 
perhaps,  even  more  obsolete  than  the  code  above  alluded  to.  The  profession  is 
now  in  no  sense  guided  by  these  codes ;  nor  does  it  seem  desirable  to  hold  it 
together  either  by  the  regulations  that  pertain  to  trades-unions,  or  by  the  moral 
platitudes  of  existing  codes,  but  it  rather  requires  for  its  wholesome  government 
clear  and  business-like  regulations,  backed  up  by  our  ample  statutory  laws,  leav- 
ing the  matter  of  moral  maxims  and  precepts,  as  well  as  personal  manners,  to 
the  social  conditions  that  surround  the  individual." 

This  report  was  signed  by  Di's.  Samuel  Sexton  (Chairman),  James  R. 
Leaming,  W.  M.  Polk,  J.  D.  Bryant,  and  Clement  Cleveland  (Secretary). 

The  foregoing  was  printed,  and  distributed  to  the  members  of  the 
society. 

At  the  annual  meeting  of  the  Medical  Society  of  tlie  State  of  New 
York,  held  February,  1881,  the  President  of  the  society,  in  his  Inaugural 
Address,  called  tlie  attention  of  the  society  to  the  necessity  for  a  change  in 
the  code  of  ethics,  perhaps  the  need  for  an  entirely  new  one. 

The  committee  to  whom  the  President's  address  was  referred  reported 
the  following  resolution : 

"  Resolved,  That  a  special  committee  of  five  be  appointed  by  the  Presi- 
dent, to  be  designated  a  '  Committee  on  the  Code  of  Ethics,'  whose  duty  it 
shall  be  to  consider  the  whole  question  of  desirable  changes  in  the  code, 
and  who  shall  present  to  the  society,  at  the  session  of  1882,  such  sugges- 
tions on  this  subject  as  their  observations  and  investigations  may  direct." 
This  resolution  was  adopted  by  the  society,  and  a  committee  of  five  was 
appointed.  Of  the  personnel  of  this  committee  the  following  may  be 
stated  :  Three  of  its  members  were  chosen  from  among  the  older  members 
of  the  society  and  the  profession,  and  two  from  among  those  who  had  been 
in  practice  between  fifteen  and  twenty  years.  Three  of  the  members  had 
been  presidents  of  the  society,  and  the  other  two  had  served  on  important 
standing  committees.  Three  were  from  the  northern,  western,  and  middle 
portions  of  the  State,  and  two  from  the  city.  Three  were  general  prac- 
titioners, and  two  were  specialists.  From  this  it  would  seem  that  the  va- 
rious interests  involved  had  been  carefully  provided  for.  The  committer 
gave  the  subject  with  which  they  were  charged  careful  and  laborious  atten- 
tion during  the  year  that  was  allotted  to  them.  The  views  of  the  different 
members  were  in  part  elicited  and  circulated  by  correspondence,  and  the 


IN  THE  STATE   OF  NEW   YORK.  25 

■views  and  feelings  of  many  of  the  more  prominent,  and  also  of  the  more 
obscure,  members  of  the  profession  were  sought.  After  a  pretty  complete 
knowledge  had  been  obtained  of  what  appeared  to  be  the  prevailing  senti- 
ment of  the  profession  throughout  the  State,  the  committee,  setting  private 
business  aside,  devoted  two  entire  days  to  the  matters  under  consideration. 
The  first  conclusion  arrived  at  was,  that,  if  the  profession  of  the  State  de- 
sired a  code,  one  should  be  reported  that  should  be  clear  and  distinct  in  its 
meaning,  and  one  that  could  be  enforced  when  necessary.  The  second 
conclusion  was  that  the  code  should  contain  nothing  that  was  already  pro- 
vided for  by  the  laws  of  the  State,  or  by  such  moral  laws  as  all,  whether 
■Christian,  Jew,  or  infidel,  considered  binding.  This  narrowed  the  matter 
to  the  formulation  of  such  rules  as  seemed  to  the  committee  most  likely  to 
he  in  harmony  with  the  sentiments  of  the  thoughtful  members  of  the  pro- 
fession, and  to  conduce  to  the  best  interests  both  of  it  and  of  the  public. 

The  two  most  important  sections  of  the  code  were,  first,  those  relating 
to  the  matters  which  the  Committee  on  Ethics  of  the  New  York  County 
Society  had  brought  to  the  notice  of  the  profession,  and,  second,  those 
which  related  to  the  question  of  consultations.  In  dealing  with  this  mat- 
ter, the  committee  carefully  examined  the  American  code,  and  found,  as 
had  been  pointed  out  by  the  New  York  County  committee,  that  it  did  not 
fully  cover  the  ground.  They,  therefore,  added  several  supplementary 
clauses,  which  made  the  completed  article  read  as  follows : 

"It  is  derogatory  to  the  dignity  and  interests  of  the  profession  for  physicians 
to  resort  to  public  advertisements,  private  cards,  or  handbills,  inviting  the  atten- 
tion of  individuals  affected  with  particular  diseases,  publicly  offering  advice  and 
medicine  to  the  poor  without  charge,  or  promising  radical  cures  ;  or  to  publish 
cases  or  operations  in  the  daily  prints,  or  to  suffer  such  publications  to  be  made ; 
or,  through  the  medium  of  reporters  or  interviewers,  or  otherwise,  to  permit 
their  opinions  on  medical  or  surgical  questions  to  appear  in  the  newspapers ;  to 
invite  laymen  to  operations ;  to  boast  of  cures  and  remedies,  or  to  perform  other 
similar  acts. 

"  It  is  equally  derogatory  to  professional  character,  and  opposed  to  the  in- 
terests of  the  profession,  for  a  physician  to  hold  a  patent  for  any  surgical  instru- 
ment or  medicine,  or  to  prescribe  a  secret  nostrum,  whether  the  invention  or 
discovery,  or  exclusive  property,  of  himself  or  of  others. 

"  It  is  also  reprehensible  for  physicians  to  give  certificates  attesting  the  effi- 
cacy of  patented  medical  or  suigical  appliances,  or  of  patented,  copyrighted,  or 
secret  medicines,  or  of  proprietary  drugs,  medicines,  wines,  mineral-waters, 
health  resorts,  etc." 

We  believe  no  open  objection  has  been  made  to  any  of  the  provisions 
of  the  foregoing  sections,  except  with  reference  to  the  matter  of  patenting 
■surgical  instruments.  It  is  claimed  by  those  who  advocate  the  propriety  of 
patenting  instruments  that  there  is  really  no  difference  between  that  and 
taking  out  a  copyright  on  a  book.  Personally,  we  can  not  regard  the  mat- 
ter in  that  light ;  for,  if  this  be  admitted,  a  parity  of  reasoning  would  in- 
dorse the  propriety  of  patenting  medicines. 


2Q  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

In  tlie  second  important  matter  connected  witli  tlie  revision  of  the  code 
— namelv.  tlie  consultation  question — the  committee  felt  that  the  gravest 
responsibility  rested  on  them.  In  dealing  "with  it,  they  believed  that  a  cor- 
rect and  lasting  solution  would  alone  be  reached  by  discarding  sentiment 
and  their  own  personal  preferences,  and  considering  the  matter  from  the 
stand-point  of  actual  fact.  It  was  perfectly  well  known  that  consultations 
between  regular  physicians  and  homoeopaths  were  of  frequent  occurrence. 
It  was  also  perfectly  clear  that  the  disposition  to  prosecute  and  discipline 
offenders  for  this  breach  of  the  code  had  disappeared.  The  last  case  of 
discipline  known  to  the  committee  was  the  Gardner  case,  fifteen  years 
ago.  It  was  also  deemed  probable  that,  since  the  homoeopaths,  by  formal 
resolution,  had  repudiated  their  "  exclusive"  position,  and  had  thus  escaped 
the  letter  of  the  code,  convictions  of  ofienders  would  be  exceedingly  diffi- 
cult ;  and  that,  if  a  society  should  convict  a  member  and  suspend  or  expel 
him,  the  courts  would,  on  technical,  if  no  other  grounds,  inevitably  rein- 
state him ;  and  a  society  repeating  such  action  would  probably  become 
amenable  to  the  charge  of  contempt  of  court,  with  its  attendant  conse- 
quences, and  possibly  liable,  also,  in  civil  damages  to  the  aggrieved  party. 
It  was  almost  morally  certain  that  no  prosecutions  of  this  sort  would  be 
undertaken,  except  by  some  indiscreet  person,  for  purposes  of  gratifying 
private  malice.  The  heresy-hunters  of  a  preceding  generation  had  mostly 
disappeared,  and  there  were  apparently  none  left  who  felt  it  their  duty  to 
act  as  public  prosecutors.  It  was  perfectly  clear  to  the  committee  that  the 
restrictive  clause  of  the  code  availed  only  with  those  who  felt  themselves  in 
honor  bound  by  its  apparent  spirit,  while  it  left  all  others  to  do  as  they 
pleased,  free  from  any  anxiety  as  to  the  consequences. 

Under  these  circumstances  the  committee  had  but  two  courses  before 
them — one  of  .which  was  the  preparation  of  a  consultation  clause  so  care- 
fully and  tightly  drawn  that  escape  from  conviction  would  be  impossible, 
or  else  to  recommend  the  abolition  of  all  restrictions  on  the  subject,  leaving 
the  matter  to  the  individual  consciences  of  all  those  who  were  interested. 
If  the  first  course  had  been  adopted,  there  is  not  a  shadow  of  a  doubt  that 
the  courts  would  have  pronounced  it  "  contra  honos  mores,''''  and  void.  The 
people  of  the  State,  as  well  as  the  legislators,  had  already  become  suffi- 
ciently indignant  against  the  profession  for  assuming  an  attitude  that  ap- 
peared to  them  bigoted,  intolerant,  and  inhumane.  The  rule  of  the  Ameri- 
can Medical  Association  was  generally  regarded "  as  iron-clad,  admitting  of 
no  exception ;  and  cases  almost  without  number  were  known  to  the  com- 
mittee in  which  medical  men  had  refused  consultation  assistance  under  cir- 
cumstances that  laid  them  open  to  the  gravest  charges  of  inhumanity,  the 
only  excuse  given  being  that  the  rules  of  their  order  forbade  them  doing 
otherwise.  The  code  of  the  American  Medical  Association,  in  its  true  and 
intentional  meaning,  is  rigid  and  inflexible ;  no  matter  what  mav  be  the 
occasion,  a  physician  meeting  or  consulting  with  an  "  irre<Tular  "  was  liable 
to  discipline. 


IN  THE  STATE  OF  NEW  YORK.  27 

The  committee,  therefore,  deemed  it  both  useless  and  unwise  either  to 
retain  the  rule  of  the  American  Medical  Association  or  to  recommend  the 
adoption  of  a  stricter  one. 

The  medico-political  aspect  of  the  question  also  received  consideration, 
and  from  two  points  of  view.  In  the  first  place,  the  effects  of  the  exclusive 
attitude  of  the  profession  on  the  homoeopathic  question  were  duly  weighed, 
and  it  was  the  unanimous  opinion  that  the  consultation  clause  of  the  code 
of  the  American  Medical  Association  had,  more  than  any  other  one  agency, 
assisted  the  homoeopaths  to  obtain  their  present  position  in  the  estimation 
of  the  public,  and  the  abolition  of  this  clause  was  the  first  step  to  be  taken 
if  it  were  desirable  that  the  people  should  again  estimate  medical  men 
according  to  their  individual  merits,  rather  than  as  upholders  of  this  or 
that  doctrine.  In  the  second  place,  those  who  had  interested  themselves 
to  obtain  legislation  on  medical  subjects  intended  to  improve  the  status  of 
the  profession  of  the  State  were  frankly  informed  that  no  relief  might  be 
expected  from  the  Legislature  so  long  as  the  profession  was  at  war  within 
itself.  When  intestine  differences  were  healed,  the  State  would  be  only 
too  glad  to  do  what  it  could  to  elevate  and  improve  the  material  condition 
of  medical  men ;  but,  so  long  as  there  were  factions,  the  State  would  take 
no  action  that  might  perhaps  aid  one  to  the  detriment  of  the  other.  These 
reasons  alone  should,  in  the  writer's  judgment,  have  been  sufficient  to  de- 
cide the  question  at  issue,  but  there  were  others  which  appeared  to  the 
committee  to  be  even  weightier.  The  relation  of  the  profession  to  the 
welfare  of  the  community  was  an  element  that  could  hardly  be  overlooked. 
To  exemplify  this  point  briefly,  it  may  be  assumed  that  the  only  instance 
in  which  a  homoeopath  would  desire  or  ask  for  a  consultation  with  a  regu- 
lar would  be  when  in  the  treatment  of  a  given  case  he  had  exhausted 
his  own  resources,  and  the  patient  still  remained  uncured.  Under  these 
circumstances,  duty  to  his  patient  certainly  demanded  that  he  should  seek 
advice  and  counsel  from  such  sources  as  in  his  judgment  would  be  best 
able  to  supply  them.  To  this  end  he  solicits  the  aid  of  a  Thomas,  a  Flint, 
or  a  Sayre,  believing  that  their  larger  experience  in  certain  departments 
may  throw  a  clearer  light  on  the  pathology  of  the  case,  or  may  enable 
them  to  suggest  a  more  successful  method  of  treatment  than  the  one  pre- 
viously pursued.  If,  now,  these  gentlemen  believe  that  their  own  methods 
are  not  superior  to  those  commonly  pursued  by  homoeopaths,  or  that  their 
skill  is  less  than  that  of  the  physician  who  seeks  their  aid,  they  certainly 
have  valid  excuse  for  declining  a  consultation.  If,  on  the  other  hand,  the 
consultant  has  reason  to  believe  that  his  experience  or  skill  may  contribute 
somewhat  to  the  recovery  of  the  patient,  it  would  certainly  seem  that  his 
duty  to  the  individual,  and,  in  a  wider  sense,  to  the  community,  was  per- 
fectly clear.  To  the  performance  of  this  duty  there  has  heretofore  been 
but  one  obstacle — the  consultation  clause  of  the  American  code. 

Still  another  aspect  of  the  question  presented  itself — namely,  the  right 
of  a  society  to  lay  down  any  restrictive  rules  for  the  guidance  of  its  mem- 


2S  THE  STATUS    OF   THE  MEDICAL  PROFESSION 

bers  which  interfered  with  the  free  exercise  of  their  talents  and  abiUties  in 
the  pursuit  of  their  calling.  It  may  be  conceded  that  there  exists  in  every 
organized  body  a  necessity  for  certain  rules  and  regulations  relative  to  its 
organization  and  continuance;  and  it  raay  be  contended  that  individual 
members  should  yield  some  of  their  personal  rights,  if  the  general  body  to 
which  they  belong  will  be  benefited  thereby.  The  present  question,  how- 
ever, does  not  appear  to  fall  within  either  category,  as  it  certainly  will  not 
be  claimed  that,  if  A  (regular)  consults  with  B  (homoeopath),  C  (regular) 
is  injured  thereby,  or  that  the  fellow-members  of  A  and  C  receive  any  det- 
riment as  a  body  from  the  action  of  A.  We,  therefore,  fail  to  see  any  good 
reason  why  A  should  be  restricted  in  the  matter  of  consultation  when  either 
his  sense  of  duty  or  his  inclinations  or  interests  are  at  stake ;  and  a  rule 
that  does  so  restrict  him  belongs  to  the  class  of  rules  which  American  citi- 
zens have  always  regarded  as  opposed  to  that  liberty  of  action  which  is  re- 
ferred to  in  the  Declaration  of  Independence,  and  guaranteed  by  the  Con- 
stitution of  the  United  States.  It  is  a  rule  utterly  opposed  to  the  principles 
that  underlie  the  National  and  State  governments  of  this  country. 

The  foregoing  may  be  regarded  as  among  the  moral  aspects  of  the  ques- 
tion, and  those  which  most  certainly  should  be  the  first  to  be  considered ; 
and  the  committee  were  of  the  unanimous  opinion  that  ordinary  morality 
and  the  welfare  of  the  community  demanded  that  the  old  rule  should  be 
abolished,  and  the  matter  of  consultation  left  to  the  good  sense  and  con- 
science of  each  qualified  practitioner. 

The  question  of  expediency  next  demanded  attention,  and  more  espe- 
cially in  its  relation  to  the  sectarian  bodies.  Would  the  proposed  action  aid 
them  to  maintain  their  antagonistic  attitude  ?  Or,  on  the  contrary,  would 
it  not,  by  removing  the  chief  excuse  for  their  existence,  tend  to  their  gradu- 
al extinction  ?  *  The  committee  were  unanimously  of  opinion  that  such 
would  be  the  effect  of  the  contemplated  action.-j-  It  must  not  be  supposed, 
however,  that  the  committee  overlooked  the  relations  which  the  State  socie- 
ty bore  to  the  American  Medical  Association.  On  the  contrary,  these  were 
considered  most  carefully  and  exhaustively ;  but  since  much  misapprehen- 
sion exists  as  to  the  relationship  between  this  body  and  the  various  societies 
which  are  represented  in  it,  we  briefly  state  the  facts : 

The  American  Medical  Association  is  a  voluntary  and  self-constituted 
l)ody,  without  charter  or  any  form  of  incorporation,  amenable  to  no  other 
authority  than  its- own  will,  and  without  power  to  exercise  authority  over 
any  other  body.  At  the  time  of  its  organization  it  adopted  certain  rules 
by  which  its  future   membership  should  be  regulated,  which  rules  have, 

"  The  doctrinal  changes  that  had  occurred  in  both  the  homcBopathic  and  regular 
schools  during  the  past  fifteen  years  were  so  great,  and  in  such  converging  lines,  that 
there  was  no  longer  any  sufficient  raison  d^etre  for  the  continuance  of  societies  whose  co- 
herence depended  on  dogmatic  or  doctrinal  peculiarities,  their  only  real  bond  of  union 
being  one  of  political  defense  against  the  aggressive  attitude  of  the  regular  profession. 

f  The  very  decided  confirmation  of  this  opinion  by  recent  events  will  be  shown  later. 


IN   THE  STATE   OF  NEW   YORK.  29* 

from  time  to  time,  been  amended  and  changed.  The  association  indicates 
the  kind  of  societies  from  which  it  will  receive  delegates,*  and  the  terms  on 
which  said  delegates  will  be  admitted.f  The  acceptance  of  these  terms  by 
the  various  State  and  other  societies  simply  permitted  them  to  be  repre- 
sented, and  to  take  part  in  the  proceedings  of  the  association. 

The  association  is  also  composed  in  part  of  what  are  known  as  "perma- 
nent members,"  namely,  persons  who  once  or  oftener  have  served  as  dele- 
gates, and  who,  in  virtue  of  this  fact  and  an  annual  payment  of  five  dollars, , 
become  entitled  to  assume  the  designation. |  The  permanent  members, 
however,  do  not  enjoy  equnl  powers  and  privileges  with  the  delegates,. 
They  are  entitled  to  seats,  and,  in  a  qualified  sense,  are  allowed  a  voice  in 
the  proceedings.  They  can  not,  however,  give  practical  force  to  any  views 
that  they  may  hold  on  topics  under  discussion,  inasmuch  as  they  are  not 
permitted  to  vote.  It  will,  therefore,  be  seen  that  the  practical  manage- 
ment of  affairs  is  taken  out  of  the  hands  of  the  older  and  more  experienced 
members  and  left  to  the  judgment  of  those  who  are  younger,  many,  if  not 
most,  of  whom  visit  the  association  for  the  first  time  ready  to  become  the 
veriest  clay  in  the  hands  of  some  wily  and  adroit  manipulator.* 

It  will  be  seen  from  the  foregoing  that  the  American  Medical  Associa- 
tion is  not  in  any  sense  a  confederation  of  State  and  dependent  societies, 
united  by  mutual  pledges  to  each  other,  as  is  the  case  with  the  States  form- 
ing the  Federal  Union,  but  simply  a  body  composed  of  such  societies  as 
find  it  to  their  inclination  or  interest  to  conform,  for  the  time  being,  to  cer- 
tain rules  and  regulations.  If,  therefore,  a  State  society  should  place  itself 
in  a  position  that  would  prevent  further  continuance  of  its  connection  with 
the  association,  such  action  can  not  be  considered  as  a  secession  in  the  same 
sense  as  a  withdrawal  of  States  from  the  Union  would  be.  It  is  not  a  vio- 
lation of  any  promise  or  pledge,  but  simply  the  severance  of  a  connection 
which,  in  this  instance,  the  committee  believed  was  at  the  present  time,  and 
under  present  circumstances,  a  source  of  injury  to  the  profession  of  the 
State. 

*  These  are  permanently  organized  State  medical  societies,  and  county  and  district  so- 
cieties entitled  to  representation  in  the  State  societies. 

\  The  adoption  of  the  association's  code  of  ethics. 

\  At  one  time  a  single  payment  of  five  dollars  and  attendance  on  a  single  meeting  of 
the  association  were  the  only  requirements  for  permanent  membership. 

*  The  constitution  of  the  New  York  State  Society  is  essentially  different.  In  this  body 
the  delegates,  in  accordance  with  the  statutes  of  the  State,  are  elected  for  four  years,  one 
fourth  of  the  total  number  being  elected  annually  and  one  fourth  retiring.  At  every  meet- 
ing, therefore,  there  will  be  those  who  are  serving  in  their  fourth  year,  others  in  their 
third,  and  others  in  their  second,  while  but  one  fourth  of  the  entire  number  of  delegates 
can  by  any  possibility  be  men  without  experience  in  society  matters.  In  addition  to  the 
delegates,  the  permanent  members  constitute  an  important  factor  in  the  society.  They 
are  chosen  from  among  such  delegates  as  have  served  three  out  of  their  four  years  of  ser- 
vice, and  the  number  that  may  be  elected  annually  is  limited  by  the  statutes  of  the  State.  ^ 
Permanent  members  have  both  voice  and  vote. 


30  THE  STATUS   OF  THE   MEDICAL  PROFESSION 

In  tlie  light  of  these  facts  and  conclusions,  the  committee  decided  to 
report  the  following  for  the  consideration  of  the  State  society : 

"  Members  of  the  Medical  Society  of  the  State  of  jSTew  York,  and  of  the  medi- 
cal societies  in  aifiliation  therewith,  may  meet  in  consultation  legally  qualified 
practitioners  of  medicine.  Emergencies  may  occur  in  which  all  restrictions 
should,  in  the  judgment  of  the  practitioner,  yield  to  the  demands  of  humanity." 

As  the  subsequent  sections  of  the  State  code  have  not  been  specially 
criticised,  we  will  not  quote  or  make  further  allusion  to  them. 

After  the  committee  had  agreed  on  their  report,  the  question  of  pub- 
lishing it  in  advance  of  the  meeting  was  considered.  The  committee  would 
have  been  glad  to  give  it  the  fullest  publicity,  but  they  were  without  au- 
thority so  to  do.  It  would  have  been  contrary  to  custom,  and  an  act  of 
disrespect  to  the  society,  for  any  of  its  committees  to  give  to  the  public  a 
contemplated  report  in  advance  of  its  presentation  to  the  body  that  had 
ordered  it.  It  was  thought  proper,  however,  to  show  it  to  some  of  the  ex- 
officers  of  the  society,  and  especially  to  those  who,  it  was  supposed,  might 
have  opposite  views  to  those  of  the  committee.  The  writer  was  responsible 
for  the  use  of  but  a  single  copy  in  this  manner.  It  was  shown  to  an  ex- 
president  of  the  society,  who,  in  a  letter  received  the  following  day,  com- 
mented on  it  as  follows  : 

"  If  the  spirit  of  the  new  code,  which  is  proposed,  and  the  spirit  of  the 
resolution  which  you  read  to  me  as  unanimously  adopted  by  the  Royal  Col- 
lege of  Physicians  of  London,  had  governed  the  profession  forty  years  ago, 
homoeopathy  would  never  have  attained  an  elevation,  in  the  opinion  of  any 
of  the  educated  or  cultivated  portion  of  the  community,  as  an  antagonistic 
school  in  medical  science.  Both  the  profession  and  the  public  would  have 
been  saved  much  evil." 


2JV  THE  STATE   OF  NEW   YORK.  3| 


FIFTH  ARTICLE. 

From  the  New  York  Medical  Journal  for  June  2,  1883. 

After  the  committee  had  agreed  as  to  the  report  that  should  be  made 
to  the  society,  it  directed  that  it  should  be  printed  in  advance  of  the  meet- 
ing, in  order  that  it  might  be  placed  in  the  hands  of  those  present  at  the 
earliest  possible  moment  after  its  reception  by  the  society.  This  was  done 
that  each  and  every  member  might  have  an  opportunity  to  carefully  con- 
sider its  contents  and  prepare  himself  to  offer  objections  to  it  if  he  saw  fit 
to  do  so.  The  report  was  printed  with  the  lines  numbered,  to  facilitate 
reference  when  it  came  under  discussion.  It  was  presented  at  the  morning 
session  of  February  6,  1883.  It  was  duly  received,  the  printed  copies  were 
distributed  to  the  members,  and  the  subject  was  made  the  special  order  for 
the  evening  session.  During  the  day,  and  up  to  the  time  of  its  formal  con- 
sideration, the  code  was  the  chief  subject  of  conversation,  and  it  is  safe  to 
say  that  it  was  looked  on  by  the  members  from  all  sections  of  the  State  as 
a  very  decided  improvement  on  the  American  code,  and  one  that,  in  its 
practical  operations,  would  accomplish  much  good  for  the  profession  in  the 
State.  The  members  present  were  apparently  almost  unanimous  in  its 
favor,  the  leading  comment  being  that  the  change  was  one  that  should  have 
been  made  years  before. 

At  the  evening  session,  the  report  of  the  committee  having  been  read, 
Dr.  Agnew  moved  that  it  be  discussed  seriatim.  Dr.  Roosa  moved,  as  an 
amendment,  that  it  be  discussed  as  a  whole,  which  was  ordered.  Dr. 
Roosa,  taking  the  floor,  then  said  :  * 

If  the  society  will  bear  with  me  in  a  few  remarks,  I  will  at  their  close  offer  a 
substitute  for  this  report.  I  recognize  the  character  of  the  gentlemen  who  have 
made  this  report.  Without  exception,  they  are  the  honored  servants  of  this  so- 
ciety ;  without  exception,  they  have  had  peculiar  opportunities  to  learn  the  will 
of  the  profession  in  this  State  with  regard  to  the  code  of  ethics.  I  also  recog- 
nize, Mr.  President,  the  very  great  diificulty  under  which  this  distinguished  com- 
mittee has  labored,  for  I  remember  that  behind  them  are  the  traditions  of  a  pro- 
fession that  believed  it  was  necessary  to  bind  each  other  with  very  strong  legal 
bonds  in  order  to  prevent  harm.    I  remember  that  they  saw  the  traditions  which 

*  The  extracts  from  the  discussions  are  taken  from  the  official  record  as  published  in 
the  Transactions  of  the  Society  for  1882. 


32  THE  STATUS   OF  THE  MEDICAL  FROFESSIOK. 

were  thought  to  be  as  obhgatory  as  tliose  of  the  Mosaic  code,  and  necessary  in 
order  to  promote  righteousness  among  medical  men.  I  therefore  see  their  diffi- 
culties, and  I  honor  the  result  of  their  labors.  I  believe  that  it  presents  a  great 
advance  over  anything  which  har  been  offered  to  our  profession  up  to  this  time.. 
But  my  objection  to  this  report  is  that  it  contains  nearly  every  one  of  those 
things  which  in  the  progress  of  time  have  become  distasteful  to  the  profession  of 
our  day.  I  believe  that  it  contains  in  it  the  very  intrinsic  objections  which  we 
constantly  make  against  the  xode  which  I  hold  in  my  hands — this  sentimental 
code  of  our  forefathers,  which  tells  us  how  our  patients  should  behave  toward 
■as,  and  which  enters  into  such  innumerable  details  as  to  the  relations  we  sustain 
to  our  fellow-men  that  it  is  impossible  to  believe  that  the  authors  of  it  thought 
the  medical  profession  was  entitled  to  any  discretion  in  the  management  of  its 
own  professional  affairs.  I  think  that,  if  the  committee  had  fully  studied  the 
Bentiment  of  the  profession  of  the  Empire  State,  they  would  have  wiped  out  th» 
code  of  ethics  from  its  beginning  to  its  end.  I  believe  they  would  have  left  such 
matters  to  be  settled  by  the  individual  discretion  and  wisdom  and  the  good  faith 
of  each  man  in  affiliation  with  this  society. 

After  further  remarks,  Dr.  Roosa  offered  the  following  substitute  for  the 
report  of  the  committee  : 

The  Medical  Society  of  the  State  of  New  York,  in  view  of  the  apparent  senti- 
ment of  the  profession  connected  with  it,  hereby  adopt  the  following  declara- 
tion, to  take  the  place  of  the  formal  code  of  ethics,  which  has  up  to  this  tim» 
been  the  standard  of  the  profession  in  this  State. 

"With  no  idea  of  lowering,  in  any  manner,  the  standard  of  right  and  honor  in 
the  relations  of  physicians  to  the  public  and  to  each  other,  but,  on  the  contrary, 
in  the  belief  that  a  larger  amount  of  discretion  and  liberty  in  individual  action, 
and  the  abolition  of  detailed  and  specific  rules,  will  elevate  the  ethics  of  the  pro- 
fession, the  medical  profession  of  the  State  of  New  York,  as  here  represented, 
hereby  resolve  and  declare  that  the  only  ethical  offenses  for  which  they  claim 
and  promise  to  exercise  the  right  of  discipline  are  those  comprehended  under  th» 
commission  of  acts  unworthy  a  physician  and  a  gentleman. 

Resolved^  also,  That  we  enjoin  the  county  societies,  and  other  organizations  in 
affiliation  with  us,  that  they  strictly  enforce  the  requirements  of  this  code. 

Dr.  H.  G.  Piffard,  of  New  York,  moved  that  the  substitute  be  referred 
to  the  Standing  Committee  on  Ethics,  to  be  reported  upon  next  year.  The 
motion  was  lost. 

Dr.  Squire,  of  Elmira,  then  spoke  to  the  subject,  and  was  followed  by 
Dr.  Van  der  Poel,  who  said : 

Let  us  for  a  moment  see  where  we  stand.  The  special  committee  upon  the 
code  of  ethics,  after  consultation,  have  presented  this  report  for  adoption.  That 
report  is  objected  to  upon  the  one  hand  by  Dr.  Eoosa,  because,  liberal  as  w» 
have  made  it,  it  does  not  go  as  far  as  he  thinks  it  should,  and  we  have  placed 
restrictions  upon  ourselves  which  Dr.  Roosa  wishes  to  have  swept  away.  On 
the  other  hand,  Dr.  Squire  thinks  that  we  have  swept  away  too  much  of  our 
restrictions  in  some  directions,  and  that  we  have  not  swept  enough  away  in 
others.  Now,  let  me  state  what  was  the  spirit  which  governed  us  in  making  up 
this  code  as  presented  in  this  report.  We  reached  the  conclusion  that  it  would 
be  impossible  to  affect  the  relations  of  man  to  man,  or  the  gentlemanly  conduct 


IN  THE  STATE  OF  NEW  YORK. 


33 


and  behavior  between  man  and  man.  We  can  not  make  a  man  a  gentleman  un- 
less he  is  made  so  by  nature ;  it  is  utterly  impossible  to  bind  men  in  these  rela- 
tions by  any  code  of  medical  ethics.  For  that  reason  we  left  these  things  out  of 
our  report.  Every  one  of  Dr.  Squire's  references  relate  to  conduct  between  man 
and  man,  and,  as  we  believe  that  no  written  restrictions  can  alfect  the  moral 
character  of  the  man,  we  simply  say  that,  in  our  opinion,  we  should  govern  our 
conduct  in  consultations  as  we  have  indicated  in  the  report.  Dr.  Roosa  goes 
further  than  we  do,  and  he  wishes  to  restrict  the  medical  profession  only  by 
those  influences  which  are  comprehended  under  the  bonds  ''  worthy  of  a  physi- 
cian and  gentleman  "  ;  and  says  that  it  is  utterly  useless  to  make  any  obligation, 
and  that  it  should  be  left  to  the  moral  decision  of  each  practitioner,  and  if  you 
choose  to  consult  with  any  man,  you  are  perfectly  at  liberty  to  do  so.  I  think 
the  time  has  come  when  consultation  should  be  made  vastly  more  liberal  than  it 
has  been.  I  have  grown  up  with  all  the  prejudices  and  tendencies  of  a  man  edu- 
cated at  the  time  I  was,  and  during  my  entire  life-time  I  have  not  consulted 
directly  or  indirectly  with  a  homoeopath,  and  therefore  I  can  speak  without  fear 
or  favor.  But,  for  a  few  years  j)ast,  I  have  been  somewhat  removed  from  active 
practice,  and  I  have  looked  over  the  question  a  little  more  dispassionately ;  and 
it  has  struck  me,  as  well  as  others,  that  our  position  in  this  respect  was  painfully 
narrow  and  restricted.  If  we  can  break  down  those  barriers  and  show  up  the 
homoeopaths  to  the  public,  and  break  down  the  barrier  which  enables  them  to 
get  sympathy  from  the  public,  and  leave  it  openly  with  the  conscience  of  every 
gentleman  to  go  or  not  to  go  as  he  sees  fit,  I  think  it  would  be  a  very  great 
advance.  There  are  many  physicians  from  the  country  here  at  this  time,  and 
doubtless  they  will  support  me  in  the  statement  that  the  instances  are  not  few  in 
which  there  are  two  physicians  in  a  village — one  a  homoeopath,  and  the  other  a 
regular  physician,  using  the  ordinary  expression.  The  homoeopathic  physician, 
perhaps,  has  a  severe  case  of  sickness,  and  it  becomes  necessary  to  have  consulta- 
tion and  advice,  and  the  circumstances  are  such  that  he  can  not  send  away  to  get 
such  consultation  and  advice.  Now,  it  seems  to  me  to  be  cruel  and  heathenish, 
although  I  have  done  it  myself  over  and  over  again,  to  hang  upon  a  miserable 
code  of  ethics  and  say  I  can  not  go.  Such  cases,  I  believe,  should  be  left  to  the 
decision  of  the  gentlemanly  feeling  and  instinct  of  the  man. 

The  present  writer  then  took  the  floor  and  objected  to  Dr.  Roosa's  sub- 
stitute, fearing  that  it  would  be  generally  interpreted  as  removing  all  restric- 
tions on  the  conduct  of  medical  men  and  lead  to  the  most  unbridled  license, 
and,  in  fact,  to  an  ethical  status  equivalent  to  that  of  the  eclectics. 

Dr.  Frazier,  of  Camden,  said : 

Now,  upon  the  one  hand  the  laws  of  this  State  say  that  certain  men  are 
physicians,  and  make  them  so  by  law  ;  and  here  we  have  simply  an  effort  made 
to  make  our  laws  comply  with  those  of  the  State  of  New  York.  By  not  doing 
so,  we  give  to  other  physicians  who  do  not  belong  to  our  school  a  very  great 
advantage  in  permitting  them  to  say,  in  different  neighborhoods:  "We  are  prac- 
ticing according  to  the  laws  of  the  State  of  New  York,  but  these  men  will  not 
meet  us  in  consultation  according  to  the  laws  of  the  State  under  which  we  all 
practice."  That  has  been  the  argument  which  they  have  used,  and  which  makes 
them  strong,  and  which  makes  us  appear  stubborn  and  weakens  us.  I  have 
always  been  of  opinion  that  we  should  be  permitted  to  meet  these  men  if  the 

3 


34 


THE  STATUS   OF  THE  MEDICAL  PROFESSIOJ^ 


permission  could  be  placed  in  proper  language ;  that  is,  if  we  could  be  permitted 
to  consult  with  them  without  making  it  obligatory  that  we  should  do  so. 

Dr.  H.  D.  Noyes,  of  New  York,  said :  • 

I  have  been  looking  for  something  which  would  explain  to  me  what  it  was 
that  gave  rise  to  this  system  of  rules  which  we  know  under  the  name  of  the  code 
of  ethics,  but  I  have  not  heard  whence  it  came.  It  seems  to  me  it  must  have 
had  a  beginning  in  controversies  and  animosities  and  peculiar  conditions,  which 
have  to  a  large  extent,  or,  perhaps,  entirely,  been  abolished.  The  present  status 
of  the  medical  profession  is  one  in  which  there  is  a  high  sense  of  personal  dig- 
nity, and  feelings  of  propriety  among  its  members  in  their  relations  to  the  pub- 
lic and  to  each  other.  At  the  same  time  we  all  know  that  a  considerable  class 
of  men — both  those  who  are  called  regulars  and  those  who  are  irregulars — are 
prone  to  do  things  improper  and  unworthy  of  gentlemen.  Now,  the  code  of 
ethics,  as  it  stands,  is  doubtless  intended  to  meet  the  latter  class  of  men,  but  I 
think  that  our  influence  in  controlling  them  is  absolutely  nugatory.  I  do  not 
believe  that  the  old  code  of  ethics  has  amounted  to  anything  in  the  way  of  re- 
strictions upon  them.  Every  physician  can  call  to  mind  instances  of  flagrant  vio- 
lation of  both  the  spirit  and  the  letter  of  the  code  by  men  who  h  ave  not  been 
called  to  account.  I  well  remember  the  feeling  of  surprise  which  came  over  me 
when  the  American  Medical  Association  met  in  the  city  of  New  York  in  1854, 
and  I  first  read  what  is  known  as  the  code  of  medical  ethics.  I  never  was 
more  struck  with  astonishment  than  with  that  document.  It  seemed  to  be 
saying  things  which  were  both  humiliating  and  unnecessary,  even  at  that  time. 
I  am  sure  that  the  sense  of  this  meeting  is  for  the  abolition  of  that  code  as  it 
now  stands.  .  .  . 

.  .  .  My  feeling  throughout  my  professional  life  has  been,  first,  to  stndy  what 
my  duty  is  to  humanity,  and,  second,  to  consider  what  my  duty  is  to  the  profes- 
sion. It  has  been  with  me  a  strong  desire,  and  continues  now,  to  see  wherein 
professional  honor  and  propriety  can  be  sustained,  and,  in  deciding  with  refer- 
ence to  consultations.  I  must  say  that  I  have  uniformly  refused  to  consult  with 
so-called  irregulars.  At  the  same  time  I  have  done  so  under  the  feeling  that  I 
was  entitled  to  protest  against  it.     I  shall  vote  in  favor  of  the  substitute. 

Dr.  E.  M.  Moore,  of  Kochester,  said : 

I  have  had  the  same  wonder  which  Dr.  Xoyes  has  expressed  as  to  where  such 
a  code  as  theirs  (American  Medical  Association  code)  could  have  come  from,  and- 
I  took  pains  at  one  time  to  investigate  in  that  direction  as  to  how  we  could  have 
had  such  a  wonderful  composition.  It  was  really  copied  almost  verbatim  from 
a  treatise  written  by  Dr.  Samuel  Percival  in  1760,  in  accordance  with  the  condi- 
tion of  society  presented  in  England  at  that  time,  which  was  entirely  ai'istocratic, 
governed  by  the  law  which  regulates  the  relations  existing  between  patron  and 
client. 

About  seven  or  eight  years  ago  this  subject  came  up  in  the  American  Medical 
Association.  It  began  to  be  doubted  whether  it  was  all  right.  I  received  at 
that  time  a  letter  from  Dr.  N.  S.  Davis,  of  Chicago,  the  father  of  the  associa- 
tion, to  whom  this  matter  had  been  referred,  and  I  gave  him  my  views  upon  the 
question,  calling  attention  to  the  fact  that  Dr.  Percival  wrote  the  article  over  a 
century  ago,  and  expressed  the  opinion  that  we  had  entirely  outgrown  such 
swaddling  clothes.     At  the  next  meeting  of  the  American  Association  the  com- 


IN  THE  STATE  OF  NEW  YORK.  35 

mittee  brought  in  their  report,  and  it  was  to  the  effect  that  the  code  of  ethics 
was  80  excellent  that  it  should  be  maintained.  ...  I  am  willing  to  strike  it  all 
Out  and  leave  the  regulation  of  our  conduct  to  the  unwritten  law,  for  we  have 
uniformly  failed  to  apply  the  rules  of  discipline  under  any  code  or  system  of 
ethics  by  which  we  have  been  governed.  .  .  . 

Additional  remarks  were  made  by  Drs.  Mosher,  Wight,  Squibb,  and 
Gray.  It  is  a  curious  fact  that  not  a  single  speaker  defended  the  propriety 
of  the  consultation  clause  of  the  old  code,  or  attempted  to  advocate  the 
merits  of  this  instrument  as  a  whole.  Many,  however,  thought  it  would 
be  better  to  defer  the  decision  of  the  question  until  after  it  had  been 
brought  to  the  notice  of  the  American  Medical  Association.  The  majority 
thought  otherwise,  and  the  vote  showed  52  in  favor  of  immediate  action  to 
18  opposed.  Immediately  after  the  vote,  Dr.  Roosa  gave  notice  that  at 
the  meeting  in  1883  he  would  move  the  adoption  of  his  "substitute." 

On  the  writer's  return  to  the  city,  the  almost  universal  expression  of 
opinion  was  in  favor  of  the  action  of  the  State  society,  the  adverse  criti- 
cisms being  very  few  in  number.  On  the  day  of  his  return  he  was  met  in 
the  street  by  a  well-known  physician,  who  asked  concerning  the  ethical 
situation.  On  being  informed,  he  said  :  "  I  suppose,  then,  I  can  call  in  a 
homoeopath  if  I  want  to."  I  replied  that  I  saw  no  reason  why  the  rule 
didn't  work  both  ways,  but  inquired  why  he  wanted  a  homoeopath.  He 
replied  that  he  had  a  very  severe  case  of  scarlet  fever  under  his  care,  and 
that  the  family  were  very  anxious,  and  desired  a  homoeopath  in  consulta- 
tion ;  and  added  that,  in  all  probability,  if  he  did  not  have  the  homoeopath, 
the  family  would  discharge  him  and  employ  the  other.  He  stated  that, 
rather  than  lose  the  family,  he  would  have  the  consultation,  provided  he 
could  not  be  disciplined  therefor.  This  gentleman  is  now  enrolled  as  one 
of  the  supporters  of  the  old  code. 

The  publication  of  the  action  of  the  State  society  permitted  the  medical 
press  throughout  the  country  to  criticise  it,  and  this  they  did  in  a  manner 
that  was  not  altogether  in  harmony  with  that  spirit  of  Christian  charity 
that  the  old  code  was  supposed  to  be  founded  on.  If  the  fasehood,  hatred, 
a,nd  malice  displayed  by  some  of  the  advocates  of  this  code  are  to  be  re- 
garded as  its  legitimate  fruits,  God  forbid  that  it  should  ever  again  be  the 
supreme  medical  law  in  this  State.  The  change  in  the  code  was  a  matter 
that  affected  the  profession  of  this  State  only,  and  was  not  the  business  or 
concern  of  any  one  outside  the  State.  The  State  society,  with  perfect  delib- 
eration, and  with  its  eyes  open,  resigned  from  the  American  Medical  Asso- 
ciation,* because  it  believed  that  the  consultation  rules  of  that  body  were 
both  morally  and  politically  wrong,  and  that  further  acquiescence  in  them 

*  The  severance  of  this  connection  was  exactly  similar  in  principle  to  that  which  oc- 
curs when  a  member,  for  reasons  that  seem  satisfactory  to  him,  severs  his  connection 
from  a  medical  society  by  resignation.  It  is  neither  an  act  of  secession,  nor  an  act  of  re- 
bellion, terms  which  have  been  used  in  this  connection  by  those  who  should  have  known 
better. 


35  THE  STATUS   OF  THE  MEDICAL  FROFESSIOl^ 

would  be  to  perpetuate  the  evils  that  had  already  accrued  from  their  ob- 
servance. 

The  medical  press  of  the  country,  in  dealing  with  the  action  of  the 
State  society,  with  few  exceptions,  failed  to  discuss  the  question  on  its 
merits.  Few,  if  auv,  sought  to  ascertain  the  real  motives  and  reasons  which 
rendered  the  change  necessary  or  desirable  ;  few  even  discussed  the  efiect 
that  the  change  would  have  on  the  affairs  of  the  'profession  in  this  State. 
Faw  appeared  to  recognize  the  fact  that  it  was  the  duty  of  the  State  society 
to  watch  over  and  protect  the  interests  of  the  profession  rather  than  to 
leave  them  to  the  tender  mercies  of  the  American  Medical  Association. 

On  the  contrary,  the  majority  of  the  press  assumed  to  view  the  subject 
in  a  light  which  reflected  most  seriously  on  the  intelligence  or  honesty  of 
the  profession  in  this  State.  One  of  the  most  prominent  charges,  and  one 
which,  after  it  had  been  first  enunciated,  passed  current  as  truth  from  one 
journal  to  another,  was  the  statement,  wholly  unverifiable  by  facts,  that  this 
movement  had  been  initiated  and  engineered  solely  by  specialists  from 
sordid  motives.*  The  large  vote  (fifty-two  to  eighteen)  by  which  the  origi- 
nal change  was  made  indicates  either  that  the  great  majority  of  the  profes- 
sion in  this  State  are  specialists,  or  else  that  a  very  considerable  number  of 
general  practitioners  were  of  but  one  mind  in  this  matter. 

It  may  be  asked  why  the  State  society  did  not  first  apply  to  the  Ameri- 
can Medical  Association  before  taking  this  action  on  its  own  account.  To 
which  we  may  re|)ly  that,  in  the  first  place,  it  did  not  desire  to  carry  a 
domestic  affair  into  the  councils  of  that  body,  to  inflict  its  own  views  on 
the  profession  of  other  States,  to  make  any  attempt  to  proselyte  in  grouud 
that  was  as  yet  unprepared,  or  to  meddle  with  the  affairs  of  those  beyond 
its  jurisdiction.  Secondly,  it  knew  the  history  of  the  American  Medical 
Association  too  well  to  expect  for  a  moment  that  it  would  listen  to  any 
propositions  looking  toward  the  liberalization  of  the  profession.  Almost 
from  the  beginning  of  the  history  of  that  association  its  practical  manage- 
ment and  the  dictation  of  its  policy  have  been  in  the  hands  of  one  man — 
one  who  is  commonly  spoken  of  as  the  "  Father  of  the  Association,"  and 
who,  so  long  as  he  retains  his  power,  will  continue  to  use  it,  as  he  has  used 
it  in  the  past,  as  an  obstacle  to  the  scientific  and  political  advancement  of 
the  profession  and  the  welfare  of  the  people.     For  evidence  on  this  point, 

*  All  of  the  Xew  York  specialists  who  had  anything  whatever  to  do  with  the  matter, 
or  voted  on  the  question,  were  members  of  the  Kew  York  Academy  of  Medicine,  which 
was  under  the  governance  of  the  American  code.  The  action  of  the  State  society  in  no 
wise  affected  the  ethical  status  of  that  body,  which  is  competent  to  adopt  any  by-laws  that 
it  chooses,  or  any  code  of  ethics  that  it  desires.  These  members  of  the  State  society, 
therefore,  who  voted  for  the  change  simply  gave  freedom  to  those  who  were  not  members 
of  the  Academy  without  releasing  themselves  in  any  manner  from  the  Academy's  code  ; 
nor  have  they,  during  the  past  eighteen  months,  made  any  effort,  or  organized  any  move- 
ment, to  change  the  ethical  status  of  the  Academy.  It  will  be  seen,  therefore,  that  the 
specialists  were  not  governed  by  the  sordid  motives  that  have  been  ascribed  to  them. 
They,  less  than  any  one  else,  have  been  affected  by  the  change. 


IN  THE  STATE   OF  NEW    YORE.  g-j- 

we  need  but  to  cite  the  latest  ethical  ordinance  adopted  by  that  body — one 
which  clearly  showed  the  animus  of  the  controlling  element  of  the  associa- 
tion, and  exhibited  its  ever-readiness  to  meddle  with  the  domestic  affairs  of 
the  individual  States.  We  refer  to  the  action  that  was  recently  taken  in 
reference  to  the  University  of  Michigan. 

At  home,  the  action  of  the  State  society  was  discussed  more  temper- 
ately. The  two  most  important  medical  journals  of  this  city  approved  the 
change,  while  one  or  two  others  of  minor  influence  were  opposed.  The 
profession  of  the  State  as  a  whole  gave  the  matter  but  limited  considera- 
tion, but  as  a  rule  a  favorable  one ;  the  old  code  was  pretty  generally  re- 
garded as  dead,  and  the  recent  action  was  simply  the  interment  of  its  re- 
mains. A  few  months  later  Dr.  E.  R.  Squibb  circulated  throughout  the 
profession  of  the  State,  in  his  personal  organ,  "  The  Ephemeris,"  a  protest 
and  an  argument  against  the  change.  This  action  was  the  first  incitement 
to  dissension  and  trouble  in  the  State,  and  we  can  not  but  regard  it  as  ill- 
judged  and  in  bad  taste.  Dr.  Squibb  is  not  a  practitioner  of  medicine,  and 
has  not  for  many  years  been  placed  in  a  position  that  would  enable  him  to 
have  a  practical  knowledge  of  the  questions  at  issue  ;  and,  even  if  he  had, 
he  should  have  left  the  discussion  to  those  whom  it  immediately  concerns. 
As  a  recognized  member  of  the  profession,  however,  he  had  a  perfect  right, 
of  course,  to  discuss  the  matter ;  but  it  would  have  been  better,  we  think, 
if  he  had  done  so  in  one  of  the  public  medical  journals,  in  which  his  views 
and  opinions  might  have  received  reply.  As  it  was,  he  of  necessity  had 
the  entire  argument  to  himself,  and  was  enabled  to  give  his  personal  views 
the  widest  distribution  that  he  chose. 

A  journal  in  a  neighboring  city,  with  even  less  motive,  endeavored  to 
excite  dissension  among  the  members  of  the  county  societies  in  this  State, 
and  incited  them  to  seditious  action,  urging  them  not  to  accept  the  edict  of 
the  State  society,  but  to  adhere  to  the  American  code,  apparently  unaware 
that  such  action  by  the  county  societies  would  be  absolutely  null  and  void. 

Our  Southern  friends  also,  with  great  unanimity,  censured  the  profes- 
sion of  the  State,  and  even  suggested  that  the  malcontents  form  a  new 
State  society,  forgetting  the  old  rule  in  physics  that  two  bodies  can  not 
occupy  the  same  space  at  the  same  time.  The  distance  which  separated 
them  from  us  and  the  different  conditions  which  surrounded  them  are  suffi- 
cient reasons  for  a  misapprehension  on  their  part  of  the  propriety  and  neces- 
sity of  our  action.  We  think,  however,  that  they  might  have  been  a  little 
more  charitable  in  the  expression  of  their  views.  They  frankly  charged  us 
with  desiring  to  affiliate  with  the  lowest  quacks  and  charlatans,  just  as  in 
the  old  antebellum  days  they  charged  every  abolitionist  and  opponent  of 
slavery  with  the  desire  to  marry  his  daughter  to  a  "  nigger."  Long  accus- 
tomed as  they  were  to  the  idea  that  slavery  of  the  body  was  right  and 
proper,  it  may  take  them  some  years  before  they  understand  why  it  is  that 
•we  in  the  North  are  unwilling  to  longer  accept  the  slavery  of  the  mind  of 
which  the  old  code  represented  the  bonds. 


33  THE  STATUS   OF   THE  MEDICAL  PROFESSION 

Shortly  after  the  meeting  of  the  State  society  in  1882,  an  attempt  was 
made  to  bring  up  the  matter  of  the  code  in  the  New  York  Academy  of 
Medicine.  Notice  was  given  that  the  action  of  the  delegates  from  the 
Academy  who  had  voted  for  the  new  code  would  be  submitted  to  the  Acad- 
emy for  its  approval  or  the  reverse. .  This  was  done  by  the  friends  of  the 
old  code  who  hoped  to  secure  an  expression  of  opinion  adverse  to  the  action 
of  its  delegates.  At  the  meeting  of  the  society  at  which  the  question  was 
to  be  considered,  Dr.  Austin  Flint,  Sr.,  first  claimed  the  floor,  and,  in  a  few 
brief  but  eloquent  words,  urged  that  the  question  be  not  brought  up  in  that 
body,  and  moved  that  all  action  on  it  be  indefinitely  postponed,  on  the 
ground  that  the  scientific  interests  of  the  association  were  too  important  to 
be  hazarded  by  the  introduction  of  medico-political  questions  of  this  char- 
acter. This  action  was  regarded  by  the  opponents  of  the  old  code  as  almost 
a  pledge  that  the  question  would  not  be  raised  again.  They  preferred  to 
abide  by  rules  and  by-laws  which  were  distasteful  to  them,  and  to  gauge 
their  conduct  in  accordance  with  ordinances  regarded  as  oppressive  rather 
than  to  risk  the  future  harmony  and  welfare  of  the  Academy.  During  the 
succeeding  months  the  advocates  of  the  State  code  rested  on  their  oars, 
but  the  supporters  of  the  American  code  were  busily  engaged  in  manufac- 
turing opinion  throughout  the  country  adverse  to  the  action  of  the  State 
society.  The  most  active  agencies  in  this  direction  were  the  "  Medical 
News"  and  the  "Ephemeris,"  both  of  which  endeavored  to  incite  sedition 
in  the  county  societies,  urging  them  to  repudiate  the  action  of  the  State 
society,  and  to  instruct  their  delegates  to  vote  for  the  repeal  of  the  State 
code. 

Thirty  or  more  of  the  county  societies  followed  this  advice,  and  in- 
structed their  delegates  to  vote  for  the  repeal  of  the  State  code.  The 
societies  that  took  this  action  were  only  those  entitled  to  a  limited  number 
of  delegates,  and  the  aggregate  vote  thus  obtained  hardly  counterbalanced 
the  votes  of  two  or  three  of  the  more  populous  counties.  In  none  of  the 
larger  counties  was  this  action  taken.  It  is  true  that  Kings  County,  enti- 
tled to  twelve  delegates,  did  at  one  meeting  instruct  its  delegates,  under 
the  urging  of  Dr.  Squibb,  to  vote  for  the  repeal  of  the  State  code,  but  this, 
action  was  rescinded  at  a  subsequent  meeting  of  the  society. 

In  New  York  County,  it  being  the  year  for  the  election  of  delegates, 
upward  of  forty  nominations  were  made  at  the  September  meeting.  Of 
these  candidates  I  do  not  recollect  the  names  of  more  than  two  or  three  who 
belonged  to  the  old  code  party.  From  the  forty  nominees,  twenty-four 
(the  number  prescribed  by  law)  were  to  be  selected.  At  the  election  in 
October,  the  entire  number  elected  were  men  opposed  to  the  old  code^ 
This  was  not  in  consequence  of  any  special  electioneering,  as  from  the  code 
standpoint  it  mattered  little  which  of  the  forty  (with  two  or  three  excep- 
tions) were  elected.  Those  elected  owed  their  election  to  the  fact  that 
they  were  suitable  persons  for  the  position,  and  were  sufficiently  popular.. 
One  or  two  of  the  unsuccessful  candidates  were  men  equally  suitable  and 


IN   THE   STATE   OF  NEW   YORK.  39 

personally  popular,  but,  their  pronounced  position  in  favor  of  the  old  code 
being  known,  they  polled  a  very  small  vote. 

After  this,  very  little  thought  or  attention  was  given  to  the  code  in  this 
city,  much  less,  in  fact,  than  in  other  parts  of  the  country,  our  neighbors 
appearing  to  be  really  more  solicitous  about  our  welfare  than  we  were  our- 
selves. Ethical  matters  slumbered,  and  it  was  not  until  the  stated  meeting 
of  the  county  society  in  January,  1883,  that  the  question  was  again  opened. 
At  this  meeting,  Dr.  L.  A.  Sayre  moved  that  the  delegates  of  the  society 
be  instructed  to  vote  for  the  repeal  of  the  State  code.  After  discussion, 
this  motion  was  lost.  Not  satisfied  with  this  expression  of  opinion  on  the 
part  of  the  society,  the  old  code  advocates  procured  the  calling  of  a  special 
meeting  for  the  announced  purpose  of  obtaining  a  vote  on  the  question.  At 
this  meeting  the  question  of  instructing  the  delegates  was  again  raised,  and 
a  motion  to  that  effect  was  lost  by  a  vote  of  60  yeas  to  147  nays. 


40  THE  STATUS   OF  THE  MEDICAL  PROFESSION' 


SIXTH  ARTICLE. 

From  the  New  York  Jledical  Journal  for  October  6,  1883. 

The  seventY-seventh  annual  meeting  of  the  Medical  Society  of  the  State 
of  New  York  convened  February  6,  1883,  and  was  opened  with  the  inaugu- 
ral address  of  the  President,  Dr.  Harvey  Jewett,  of  Ontario  County.  From 
this  address  I  extract  the  following : 

At  the  anoual  meeting  in  February,  1881,  this  society  appointed  a  committee 
of  five,  from  among  the  most  distinguished  medical  gentlemen  of  the  State,  to 
consider  and  revise  the  old  code  of  medical  ethics  which  had  governed  our 
action  for  nearly  forty  years.  In  conformity  with  the  instructions  given  this 
committee,  they  presented  their  report  at  the  annual  meeting  in  1882.  At  the 
same  time  a  substitute  was  offered  to  this  effect :  that  we  abolish  all  restrictions 
relative  to  the  practice  of  medicine,  as  superfluous  and  unnecessary  in  the  pres- 
ence of  the  unwritten  or  higher  law,  leaving  all  ethical  questions  to  be  settled  by 
the  gentlemanly  instincts  of  the  profession.  The  report  of  the  committee,  as 
well  as  the  substitute,  R^as  printed  and  placed  in  the  hands  of  all  members  of  the 
society  who  desired  a  copy,  that  they  might  examine  and  vote  deliberately  and 
understandingly  upon  the  changes  reported  for  their  consideration  and  adoption. 
After  a  general  discussion,  in  which  all  present  had  an  opportunity  to  express 
their  views,  the  report  of  the  committee  was  adopted  by  a  large  majority.  The 
new  code  has  not  been  received  by  the  profession  or  the  medical  press,  in  this 
and  in  other  States,  with  cordiality  or  favor,  but,  on  the  contrary,  by  the  most 
outspoken  and  emphatic  opposition.  The  county  societies,  at  their  first  meet- 
ings, expressed  their  surprise  at  and  disapproval  of  the  new  code  adopted  by  a 
majority  of  their  representatives,  as  unbecoming  the  dignity  of  the  profession, 
and  as  revolutionary  in  its  nature  and  "  disorganizing  in  its  tendency."  A  year's 
consideration,  a  calm  and  dispassionate  discussion  of  the  matter,  have  greatly 
modified  the  views  of  the  profession  in  reference  to  the  objectionable  measure, 
and  I  trust  a  more  conservative  sentiment  exists  to-day  than  at  the  time  of  its 
adoption. 

The  American  Medical  Association,  at  its  annual  meeting  at  St.  Paul,  in  June, 
1882,  refused  admission  to  the  delegates  from  the  Medical  Society  of  the  State  of 
Isew  York,  because  they  failed  to  recognize  some  of  the  provisions  of  the  old 
code  which  had  controlled  their  action  for  so  many  years,  and  had  taken  the 
liberty  to  substitute  what  was  deemed  a  more  progressive  and  liberal  spirit  in 
reference  to  established  rational  medicine  as  it  exists  at  the  present  time.  The 
objectionable  clause  in  the  new  code  consists  in  the  sion  of  consultation 


IN  THE  STATE  OF  NEW   YORK.  4X 

with  any  legally  qualified  practitioner  of  medicine  as  not  derogatory  to  the  in- 
terest and  dignity  of  the  profession,  in  cases  of  emergency,  or  where  such  aid  is 
required  upon  the  broad  ground  of  common  humanity. 

The  advocates  of  the  new  code  assert  that  this  is  merely  permissive  ;  that  no 
one  is  under  obligation,  expressed  or  implied,  to  meet  an  irregular  practitioner 
in  consultation,  unless  he  prefei-s  to  do  so  ;  but  in  certain  cases  it  would  be  illib- 
eral, inhumane,  and  contrary  to  the  spirit  of  the  age,  to  withhold  professional  aid 
because  of  "difference  of  opinion  in  creed  or  belief."  The  attention  of  the  so- 
ciety at  this  meeting  is  directed  to  a  consideration  of  the  merits  of  this  subject, 
to  confirm,  modify,  or  abolish  the  new  code,  as  in  their  wisdom  and  judgmen'' 
they  may  deem  most  conducive  to  the  welfare,  dignity,  and  interests  of  the  medi 
cal  profession  of  the  State  of  New  York. 

At  the  conclusion  of  the  President's  address  the  standing  committees  of 
the  society  were  announced,  and  after  that  communications  from  county 
societies,  as  the  first  order  of  business,  were  called  for.    The  following  were 

presented : 

Medical  Society  of  the  County  of  "Westchester,  \ 
Katoxah,  February  5,  1883.  ) 

To  the  State  Medical  Society : 

The  following  action  was  taken  by  the  society  at  its  annual  meeting  in  1882 : 

EesoUed,  That  this  society  reaffirm  its  loyalty  to  its  parent  body,  the  Ameri- 
can Medical  Association,  and  thus  declare  its  adherence  to  the  code  of  ethics  pre- 
scribed by  that  body  as  a  guide  in  practice.  It  strongly  deprecates  the  action  of 
the  State  society,  and  maintains  that  such  action  is  as  unworthy  as  it  is  revolu- 
tionary ;  and  that  the  adoption  of  such  a  code  under  such  circumstances  could 
result  only  in  confusion  and  dishonor. 

Resolved.,  That  these  resolutions  be  submitted  to  the  State  Medical  Society  at 
its  next  annual  meeting  through  our  regular  delegates. 

Carried.     Affirmative,  28  ;  negative,  2. 

(J.  G.  "Wood,  Secretary  pro  tern.) 

J.  Francis  Chapman,  Secretary. 

Rochester,  !N".  T. 
At  the  annual  meeting  of  the  Monroe  County  Medical  Society,  held  in  the 
Common  Council  chambers  at  Rochester,  N".  Y.,  May  31,  1883,  it  was 

Resolved,  That  it  is  the  sense  of  the  Monroe  County  Medical  Society  that  the 
code  of  ethics  be  repealed,  and  that  the  secretary  notify  the  Medical  Society  of 
the  State  of  New  York  of  the  action  taken. 

"William  F.  Sheehan, 
Secretary  of  the  Monroe  County  Medical  Society. 

Oswego,  N.  Y.,  January  31,  1883. 
To  the  New  YorTc  State  Medical  Society  : 

At  the  annual  meeting  of  the  Oswego  County  Medical  Society,  held  in  Oswe- 
go, June  13,  1882,  the  following  resolution  was  adopted,  and  the  delegates  to  the 
next  meeting  of  the  New  York  State  Society  were  instructed  to  bring  the  same 
before  the  society : 

Resolved,  That,  in  regard  to  ethics  of  consultations,  the  true  rule  of  our  pro- 
fession is  that,  while  we  should  be  free  to  visit  the  siok  under  all  circumstances 
and  under  whosever  care,  it  is  unworthy  of  us  to  call  in  consultation  any  but 
regular  practioners.  p_  ^^  j^^^^^  Secretary. 


42  THE  STATUS   OF  THE  MEDICAL  PROFESSION. 

After  tlie  transaction  of  some  further  business,  Dr.  E.  R.  Squibb,  of 
Kings  County,  offered  tlie  following : 

Whereas,  The  Special  Committee  on  the  Code  of  Ethics,  in  its  report  at  the 
last  annual  meeting,  recommended  a  change  in  one  part  of  the  code  which  was 
more  in  the  nature  of  a  revolution  than  of  a  revision,  and,  therefore,  may  he 
more  radical  than  was  expected  or  desired  by  the  constituency  of  this  society ; 
and, 

Whereas,  That  report  was  adopted  at  a  session  wherein  only  fifty-two  mem- 
bers voted  in  the  affirmative,  and  thus  legislated  for  the  entire  profession  of  the 
State  on  a  subject  of  vital  importance  in  a  direction  which  may  not  have  been 
anticipated  or  desired  by  the  profession  at  large ;  therefore, 

Be  it  resolved,  That  all  the  action  taken  at  the  annual  meeting  of  1881,  in  re- 
gard to  changing  the  code  of  ethics,  be  repealed,  leaving  the  code  to  stand  as  it 
was  before  such  action  was  taken. 

Hesohed,  That  a  new  Special  Committee  of  five  be  nominated  by  the  Nomi- 
nating Committee  of  the  society,  and  be  appointed  by  the  society  to  review  the 
code  of  ethics,  and  to  report  at  the  annual  meeting  of  1884  any  changes  in  the 
code  that  may  be  deemed  advisable. 

Besolved,  That  the  report  of  the  committee  be  discussed  at  the  meeting  of 
1884,  and  be  then  laid  over  for  final  action  at  the  meeting  of  1885. 

These  resolutions  were  made  the  special  order  for  the  evening  session. 
At  this  session  the  society  went  into  committee  of  the  whole,  and  Dr. 
Squibb  opened  the  discussion,  maintaining  that  the  action  of  the  last  an- 
nual meeting  upon  the  subject  of  the  code  of  ethics  was  contrary  to  the 
plan  of  the  organization  of  the  society,  and  to  the  letter  and  the  spirit  of 
self-government  by  majority  rule,  and,  therefore,  ought  to  be  reversed. 

Dr.  Squibb  then  went  on  to  claim  that  the  code  of  ethics  was  a  part  of 
the  constitution  of  the  society,  and  analogous  to  the  constitution  of  the 
State,  and  that  any  amendments  to  be  made  in  it  should  first  be  approved 
by  the  county  societies. 

Dr.  Roosa,  then  taking  the  floor,  said : 

The  Medical  Society  of  the  State  of  New  York,  as  one  of  its  inherent  rights, 
has  the  power  to  make  its  own  by-laws,  and,  by  statute  law,  it  has  the  right  to 
call  to  the  bai*  any  county  society  which  may  refuse  to  cause  its  by-laws  to  con- 
form to  those  of  the  State  Medical  Society.  The  argument,  under  the  circum- 
stances under  which  we  meet  to-night,  is  utterly  absurd.  "What  has  happened? 
It  is  true  that  instructed  delegates  havex;ome  here  from  several  county  societies, 
and  it  is  also  true  that  from  these  very  counties  have  come  men  who  have  been 
made  permanent  members,  and  who  are  entirely  at  variance  with  the  instruc- 
tions given  to  the  delegates.  It  is  a  most  unwarrantable  doctrine  that  the  city 
of  New  York,  M'ith  its  nearly  two  millions  of  people,  and  nearly  two  thousand 
regular  physicians,  that  the  county  of  New  York,  representing  a  constituency 
something  like  that  of  twenty  counties  in  this  State,  is  not  to  have  her  full  and 
proportionate  voice  in  the  discussion  and  decision  of  any  question  which  comes 
before  us  here.  Because  she  has  the  misfortune  to  be  a  city,  and  a  large  city,  is 
her  vote  to  be  counted  only  equal  to  that  of  Alleghany?  I  believe  that  this  so- 
ciety is  of  one  accord  that  the  argument  of  Dr.  Squibb  is  not  sufficient  for  it,  and 


m  THE  STATE   OF  NEW   YORK.  4.3 

that  the  State  society  is  prepared  to-night,  whatever  it  may  have  been  on  pre- 
vions  occasions,  to  settle  this  question  for  itself,  without  referring  it  back  to  the 
counties.  The  State  society  undertook  this  action  of  revising  the  code,  not  aa 
has  been  charged  very  frequently  during  the  year,  not  at  the  suggestion  of  spe- 
cialists, not  by  any  arrangement  beforehand.  If  there  ever  was  a  spontaneous 
convention  on  the  face  of  the  earth,  if  there  ever  was  a  convention  which  repre- 
sented its  constituents,  it  was  the  annual  meeting  of  the  Medical  Society  of  the 
State  of  New  York  in  1882,  and  it  has  been  equaled  in  the  annals  of  this  society 
only  by  the  immense  meeting  of  to-night.  At  that  meeting  this  society  not  only 
passed  the  revised  code,  but,  without  caucusing  or  consultation  with  any  person 
as  to  whether  they  could  or  would  support  it,  it  passed  a  resolution  much  more 
radical,  which  had  not  been  presented  to  any  person,  except  one,  before  it  was 
oflriered  to  this  society  at  that  meeting.  That  meeting  of  the  society  did  repre^ 
sent  its  constituency  perfectly  well,  and  so  does  the  meeting  of  the  society  to- 
night. There  was  no  unfair  action  of  any  kind  in  the  meeting  of  last  year,  what- 
ever may  have  been  the  statements  from  any  source.  It  was  an  open  discussion, 
and  the  distinguished  gentleman  who  has  opened  the  debate  had  his  full  say,  and 
he  was  unable  to  convince  even  one  third  of  the  meeting  that  his  views  were 
correct.  It  is  assumed  in  the  argument  of  the  gentleman  that  we  have  such  a 
union  with  the  American  Medical  Association  that  we  are  compelled  to  ask  that 
association  before  we  make  any  change  in  our  by-laws.  Perhaps  that  question 
has  been  suflBciently  answered  ;  and  a  large  number  are  present  to-night  who  did 
not  hear  the  discussion  which  took  place  this  morning  on  that  part  of  the  sab- 
ject.  Let  us  understand  ourselves  distinctly.  We  recognize  no  allegiance  ta 
the  American  Medical  Association  except  that  of  fraternal  relations,  and  in  case 
they  refuse  to  admit  our  delegates,  as  they  refused  to  do  last  year,  this  relation 
is  dissolved.  That  association  is  not  an  incorporated  association.  If  we  ever 
subscribed  to  its  code,  we  repealed  that  subscription  last  year.  The  American 
Medical  Association  has  not  taken  a  position  in  the  medical  world  to  be  com- 
pared with  this  society  of  which  we  have  the  honor  to  be  members.  There  is 
no  secession  in  this  business.  There  is  no  States  rights  in  our  action.  If  the 
union  of  these  States  was  no  more  than  that  which  exists  between  the  American 
Medical  Association  and  this  State  Medical  Society,  there  never  would  have  been 
a  rebellion.  There  would  have  been  no  need  of  one.  Each  State  would  have 
been  independent,  as  we  are  now  of  the  so-called  National  Association.  The 
gentleman  lays  great  stress  on  the  adjective  ''revolutionary."  Revolutionary  I 
We  are  not  afraid  of  that  word.  All  the  advances  in  the  world  have  been  made 
by  revolutions;  but  revolutions  are  never  revolutions  except  as  they  are  mouth- 
pieces of  the  people,  and  a  revolution  in  this  society  will  never  be  successful 
unless  we  represent  the  voice  of  the  medical  profession  of  the  State  of  New 
York.  Not  of  us  in  New  York  can  any  charge  of  misrepresentation  be  made. 
The  county  of  New  York  comes  up  here  with  its  hands  untied  and  without  fet- 
ters, and  any  member  is  at  liberty  to  vote  as  his  conscience  may  dictate.  The 
county  of  Kings,  thanks  to  great  effort  in  opposition  to  the  gentleman  who  has 
just  spoken,  is  also  unfettered  upon  this  floor.  But,  I  am  sorry  to  say,  I  am 
addressing  some  gentlemen  who  never  had  an  opportunity  to  listen  to  arguments 
on  the  side  of  those  of  us  who  believe  that  an  advance  of  the  profession  will  be 
most  effectually  promoted  by  our  assistance  to  the  resolutions  offered  to-night, 
and  they  come  up  here  bound  and  directed  as  to  what  they  shall  do.  I  consider 
these  instructions  as  utterly  illegal ;  and,  when  I  had  the  honor  to  be  president 


44  THE  STATUS   OF  TEE  MEDICAL  PROFESSION 

of  this  society,  I  ruled  that  these  instructions  were  invalid,  and  one  gentleman 
from  New  York  violated  his  instructions,  and  he  was  never  disciplined,  although 
he  was  threatened.  No,  Mr.  President,  not  upon  ns  can  any  charge  of  revolu- 
tion be  fastened  except  that  which  is  simOar  to  what  has  emancipated  many  a 
country,  and  which  will  emancipate  the  State  of  New  York.  The  few  other 
arguments  wliich  have  been  advanced  against  the  new  code  are  easily  answered. 
It  has  been  assumed  by  the  friends  of  the  old  code  that  we  have  played  com- 
pletely into  the  hands  of  the  homoeopaths  and  the  eclectics,  if  consultation  with 
any  class  of  legally  qualified  practitioners  be  allowed.  Now,  if  you  are  not  will- 
ing to  trust  the  ex-presidents  of  this  society,  who,  with  very  few  exceptions,  are 
entirely  in  favor  of  this  expression  of  freedom  in  consultation,  and  the  commit- 
tee, not  of  specialists,  but  of  a  majority  of  general  practitioners  who  drew  up  this 
code — if  you  are  not  ready  to  trust  them  as  to  whether  we  are  going  to  surren- 
der in  any  such  way,  then  I  have  misunderstood  this  society. 

It  has  also  been  said  that  this  is  a  medical  question,  and  that  it  can  not  be  in 
any  manner  understood  by  men  outside  of  the  medical  profession.  If  this  was 
a  question  as  to  the  value  of  iodide  of  potassium,  or  sulphide  of  calcium,  or  the 
sulphate  of  quinine  as  agents  for  controlling  the  symptoms  of  disease,  then  none 
except  men  like  ourselves,  who  have  received  a  medical  education  and  have  had 
experience  in  its  practical  application,  are  competent  to  decide  it.  But  it  is  not 
a  question  of  drugs  or  drugging.  It  is  a  question  of  ethics,  a  question  of  man's 
rights,  his  relations  to  his  brother  man,  and  his  entire  conduct  toward  the  people 
of  this  community.  The  entire  sentiment  and  conduct  of  the  people  is  against 
this  restricted  trades-union  clause  in  the  American  Medical  Association  code,  and 
they  have  a  right  to  their  opinion,  and  are  competent  to  give  an  opinion  upon 
this  question.  The  old  code  of  our  profession  has  made  us  the  laughing-stock  of 
educated  men.  "We  claim  for  ourselves,  not  the  privilege  of  affiliating  with 
quacks,  but  of  giving  onr  advice  wherever  it  is  asked  for. 

If  we  act  simply  as  benefactors  to  our  own  kind,  no  matter  if  we  stand  alone 
for  the  next  hundred  years,  we  shall  be  right,  and  the  Medical  Society  of  the 
State  of  New  York  can  afford  to  smile  at  those  who  refuse  it  fellowship. 

Dr.  H.  G.  Piffard,  of  Xew  York,  then  said : 

I  desire  to  throw  a  little  light  upon  one  point  raised  by  the  gentleman  from 
Kings.  He  drew  an  analogy  between  the  constitution  and  by-laws  of  this  so- 
ciety and  the  constitution  and  laws  of  the  State.  His  special  effort  is  to  show 
that  the  code  of  ethics  was  virtually  the  constitution  of  this  State  society,  and" 
that  it  could  not  be  altered  except  by  the  consent  of  the  constituencies  from 
which  the  society  is  recruited.  This  view,  I  think,  is  erroneous.  The  code  of 
ethics  we  have  adopted  is,  and  always  has  been  before,  regarded  as  a  by-law 
simply.  The  gentleman  from  Kings  County  seems  to  think  that  we  derive  our 
authority  from  county  medical  societies,  that  we  have  no  authority  over  them, 
and  that  our  by-laws  are  subject  to  their  revision,  instead  of  their  by  laws  being 
subject  to  the  revision  of  the  State  Medical  Society.  In  that  the  gentleman  is 
absolutely  mistaken.  He  quotes  from  a  certain  law  enacted  in  1813,  which  gives 
ns  the  power  to  make  certain  by-laws,  and  also  gives  county  medical  societies 
power  to  make  certain  by-laws,  but  he  overlooks  the  fact  that  in  1866  another 
law  was  passed  which  enabled  the  State  society  to  control  the  by-laws  of  county 
societies.  ...  In  other  words,  county  societies  are  amenable  to  this  society,  not 
this  society  amenable  to  the  county  societies.  ... 


IN  THE  STATE   OF  NEW   YORK.  45 

Dr.  H.  R.  Hopkins,  of  Erie,  then  addressed  the  Committee  of  tke 
Whole.* 

Dr.  Didama,  of  Onondaga  County,  next  spoke.  Referring  to  the  Ameri- 
can code,  he  said  : 

.  .  .  This  code  is  the  one  which  we  adopted  on  condition  of  representation 
in  the  American  Medical  Association.  If  we  repeal  it,  then  we  have  no  rightful 
representation  in  that  association.  It  was  repealed  by  a  few,  hut  their  action 
was  not  the  expression  of  the  great  mass  of  the  profession  of  this  State,  only 
fifty- three  persons  voting  one  way,  and  they  did  not  represent  the  opinion  of 
four  or  five  thousand  regular  practitioners  of  medicine  in  this  State.  There  is  a 
little  complaint  that  our  delegation — which  was  sent  after  our  secession,  if  you 
choose  to  call  it  so,  our  cutting  ourselves  loose  from  the  American  Medical  As- 
sociation— was  not  received  with  respect  and  open  honor.  But  I  think  every 
fair-minded  man  must  allow  that  the  association  could  have  done  nothing  else. 
They  were  bound  to  reject  the  delegates  sent  from  a  society  which  had  repudiated 
the  code  of  ethics  established  for  the  government  of  the  entire  profession.  The 
question  is,  Are  we,  the  medical  profession  of  the  State  of  New  York,  prepared 
to  cut  ourselves  loose  from  the  American  Medical  Association? 

Dr.  Didama  further  stated  that  he  considered  a  consultation  with  a 
homoeopath,  with  a  person  who  believed  in  the  efBcacy  of  the  so-called  di- 
lutions, as  conniving  at  a  fraud. j-     In  closing,  he  said  : 

With  this  I  shall  end,  saying  that  a  consultation  with  certain  persons  is  de- 
rogatory to  the  medical  profession,  and  that  it  is  derogatory  because  those  who 
do  it  are  simply  perpetrating  a  fraud. 

Dr.  Rochester,  of  Erie  County,  then  spoke  :   ■ 

I  arise  with  a  full  consciousness  and  appreciation  of  the  soberness  of  this  dis- 
cussion to-night,  and  I  hope  that  anything  which  I  may  say  will  be  entirely  free 
from  personality.  We  have  to  look  to  common  sense  in  this  matter.  I  have 
been  looking  over  this  paper  (State  Code),  and  I  have  not  seen  any  line  of  it 
which  tells  us  what  is  to  he  gained  by  this  proposed  modification,  except  that 
broad  humanity  requires  us  to  meet  everybody  who  calls  upon  us.  This  I  would 
say  is  simply  a  reflection  on  the  medical  profession  throughout  the  length  and 
breadth  of  the  land,  for  there  is  no  emergency,  no  casualty,  no  case  of  distress  or 
anxiety  to  which  medical  men  do  not  always  go  under  any  circumstances,  with- 
out expectation  of  reward  or  remuneration.  .  .  .  Now,  sir,  I  am  a  permanent 
member  of  the  American  Medical  Association,  and  I  have  been  for  a  long  time 
a  permanent  member  of  that  body,  as  I  am  of  this  society,  and  I  am  proud  of  it, 
and  I  should  be  sorry  to  give  it  up.  But  I  will  say  if  this  new  code  passes  I  will 
give  up  my  membership  in  the  State  Medical  Society  sooner  than  my  permanent 
membership  in  the  American  Medical  Association.  ... 

Referring  to  mixed  consultations,  Dr.  Rochester  said : 

We  meet,  we  talk,  but  do  not  agree  in  therapeutics,  very  likely  not  in  diag- 

*  As  Dr.  Hopkins's  remarks  have  already  been  published  in  full  in  the  columns  of  the 
"  N.  Y.  Med.  Journal,"  they  are  here  omitted. 

f  See  "N.  Y.  Med.  Journal"  for  August  18,  1883,  pp.  177,  178. 


46  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

Bosis,  and  the  people  are  satisfied;  but  how  is  it  with  the  patient?  Does  the 
patient  get  any  benefit?  Not  at  all.  We  say  we  can  not  see  anything  to  do  dif- 
ferent from  what  is  being  done,  and  if  we  did  suggest  anything  it  would  not  be 
carried  out.  It  is  impossible  for  any  such  thing  to  take  place.  We  can  not  do 
it  without  degrading  ourselves.  We  maintain,  then,  our  first  position — that  we 
are  kind,  generous,  and  liberal  to  all  those  who  call  upon  us,  and  always  have 
been,  and  I  do  not  see  any  possible  advantage  which  can  come  from  this  modifi- 
cation. Perhaps  we  are  mistaken.  Now,  we  know  that  while  they  are  carry- 
ing these  colors  they  are  giving  the  very  drugs  that  regular  practitioners  do,  ex- 
cept that  sometimes  they  give  a  little  more. 

Dr.  Seymour,  of  Rensselaer  County,  then  spoke  to  the  question,  but 
his  remarks  were  too  voluminous  to  be  given  in  full,  and  will  hardly  bear 
condensation.  We  must,  therefore,  refer  the  reader  to  the  official  report. 
Referrino-,  however,  to  certain  members  of  the  profession  residing  in  a 
neighboring  county,  he  said :  "  This  thing  will  not  do,  and  if  you  come  up 
here  to  strengthen  the  hands  of  these  men  against  us,  we  will  arraign  you 
before  this  society,  and  kill  you  off  professionally ;  and,  if  you  are  backed 
up  by  your  confreres,  we  will  twist  their  necks  off  too.  That  cock  will  not 
crow."  During  Dr.  Seymom"'s  remarks  he  was  interrupted  by  the  receipt 
of  a  telegram  from  Dr.  L.  A.  Sayre  of  New  York.  Relative  to  this  tele- 
gram Dr.  Seymour  said :  "  It  is,  perhaps,  under  the  circumstances,  hardly 
in  order,  but  Dr.  Sayre's  name  was  mentioned,  and  then  it  was  stated  that 
he  had  met  with  homoeopaths,  and  confirmed  the  new  code,  and  violated 
the  old  code,  and  I  took  the  liberty  of  sending  a  telegram  to  Dr.  Sayre, 
telling  him  that  the  charge  had  been  made  ;  and  I  understood  that  a  letter 
proving  the  charge  would  be  read  at  this  meeting,  and  called  upon  Mm  to 
vindicate  himself,  and  I  got  this  telegram  from  some  one  in  his  house : 
'  Dr.  Sayre  has  been  confined  to  his  bed  for  two  weeks,  and  it  is  impossible 
for  him  to  be  moved  at  present.  He  says :  "  I  saw  in  consultation  Dr. 
Baldwin,  who  was  treating  the  patient  most  heroically  all  through.  He 
had  not  diagnosed  the  case,  and  afterward  I  learned  that  he  was  a  homoeo- 
path, although  from  what  I  saw  of  him  no  one  would  suspect  that  he  was. 
He  was  at  the  time  using  hypodermic  injections  of  morphine,  and  in  no 
respect  carrying  out  the  principles  of  Hahnemann."  '  " 

Dr.  Seymour  further  said :  "  Once  or  twice  in  my  life  I  have  violated 
the  code  myself,  and  been  to  consult  with  homoeopaths — once  in  a  case  of 
placenta  prfevda,  where  the  woman  was  bleeding  to  death.  After  I  had 
righted  things  up,  and  got  the  woman  so  I  thought  she  would  live,  I  turned 
around  to  this  homoeopathic  gentleman  and  said  to  him,  'You  have  abun- 
dant time  now  to  consult  with  one  of  your  own  kind,  and  I  will  not  trouble 
you  any  further.'  For  this  consultation  I  was  condemned,  and  I  had  to 
vindicate  myself  upon  the  principle  of  humanity." 

This  concluded  the  arguments  on  the  question  before  the  society.  After 
some  parliamentary  skirmishing,  the  question  was  taken  on  Dr.  Squibb's 
resolutions.     The  result  of  the  vote  showed  99  ayes  to  105  nays,  and  the 


TN    THE  STATE  OF  NEW    YORK. 


47 


resoltitions  were  declared  lost.     To  carry  tliem  would  have  required  a  two- 
thirds  aflBrmative  vote,  which  in  the  ballot  cast  would  have  been  136. 

The  result  of  this  ballot  exhibited  one  fact  with  great  distinctness — 
namely,  that  the  majority  of  the  representatives  of  the  profession  of  this 
State  were  not  in  favor  of  a  restoration  of  the  old  code.  It  had  been  re- 
peatedly predicted  by  the  hostile  press  outside  the  State  that  the  action  of 
the  State  society  of  the  previous  year  would  be  reversed  at  this  meeting. 
The  vote  showed,  only  too  clearly,  that,  despite  the  exertions  that  had  been 
made  in  behalf  of  the  old  code,  and  despite  the  abuse  that  had  been  heaped 
on  us  from  without,  the  profession  of  the  State  were  thoroughly  convinced 
of  the  evil  effects  of  the  code  in  the  past,  and  were  not  going  to  submit  to 
them  in  the  future,  even  at  the  expense  of  loss  of  representation  in  the 
American  Medical  Association. 

Subsequent  to  the  announcement  of  the  vote.  Dr.  Roosa  moved  the 
adoption  of  his  "substitute,"  which,  on  motion,  was  laid  over  until  1884. 
Dr.  J.  G.  Adams  entered  a  protest,  as  delegate  from  the  New  York  Academy 
of  Medicine,  against  the  action  of  the  State  society.  This  protest  was 
clearly  an  impropriety  if  offered  in  behalf  of  the  Academy,  and  should  not 
have  been  received  as  an  expression  of  the  Academy's  feelings  and  views, 
inasmuch  as  a  majority  of  the  delegates  of  the  Academy  who  were  present 
voted  with  the  majority.  It  may  further  be  stated  that  the  Academy  had 
not  expressed  its  Tiews  on  the  subject,  and,  as  a  curiosity  in  the  matter  of 
society  by-laws,  it  may  be ,  stated  that  the  members  of  the  Academy  have 
no  direct  voice  in  the  selection  of  the  delegates  that  are  supposed  to 
represent  them,  either  in  the  State  society  or  in  the  American  Medical 
Association. 

■  On  the  second  day  of  the  session  the  Committee  on  Legislation  made 
its  report,  and  during  its  discussion  the  question  of  ethics  was  incidentally 
revived.  The  committee  having  asked  for  an  appropriation  of  five  hundred 
dollars,  for  the  purpose  of  procuring  legal  assistance,  with  the  view  to  de- 
sirable legislation,  Dr.  Hopkins,  of  Buffalo,  spoke  in  favor  of  the  motion  to 
adopt  the  report,  to  which  Dr.  Van  de  Warker,  of  Onondaga  County,  replied 
as  follows: 

I  did  have  great  hopes  for  the  cause  of  medical  education  in  this  State,  not- 
withstanding the  fact  that  nearly  every  attempt  this  State  has  made  to  regulate 
the  practice  of  medicine  has  been  a  terrible  failure — so  terrible  that,  if  medical 
men  attempt  to  make  laws,  it  is  to  be  hoped  that  they  will  be  such  laws  as  will 
be  of  benefit  to  the  profession.  The  law  of  1880,  which  legalized  every  quack, 
was  a  deplorable  failure,  and  the  law  of  1874,  which  gave  the  medical  societies 
of  this  State  certain  powers,  was  another  terrible  failure,  and,  every  time  this 
society  has  attempted  to  dabble  in  medical  law  at  all,  the  profession  at  large  has 
deplored  the  fact. 

Dr.  Sturgis:  I  would  ask  the  gentleman  from  Onondaga  if  any  eflPorfc  has 
been  made  in  his  county  to  prosecute  illegal  practitioners? 

Dr.  Van  de  Warker :  An  Indian  doctor  rode  through  our  principal  streets 
the  other  day,  adorned  with  war  paint  and  feathers,  and  he  registered  in  the 


48  THE  STATUS    OF  THE  MEDICAL  PROFESSION 

Clerk's  oflBce,  and  is  now  considered  a  legalized  practitioner,  and  he  stands  on 
the  same  footing  with  the  other  members  of  the  profession. 

Dr,  Sturgis :  Has  any  attempt  been  made  to  prosecute  illegal  practitioners  in 
your  connty  ? 

Dr.  Van  de  TTarker :  Prosecution  was  not  attempted  in  my  county.  .  .  .  The 
legislation  of  1880  was  not  to  protect  the  regular  practitioner,  but  to  protect 
quacks,  just  as  the  code  indorsed  last  night  was  not  for  the  regular  profession, 
but  for  quacks. 

Dr^  Sturgis :  I  do  not  think  the  gentleman  can  speak  fairly  of  a  point  which 
has  not  been  tried  in  his  own  connty,  and  in  which  he  has  not  liad  any  experi- 
ence. At  aU  events,  what  he  states  is  at  variance  with  what  has  been  the  ex- 
perience of  the  iledical  Society  of  the  County  of  Xew  York,  and  the  same  is  good 
for  every  county  medical  society  in  the  State.  "When  that  law  passed,  the  physi- 
cians of  New  York  made  up  their  minds  to  make  a  fair  ti'ial  of  it,  and  to  deter- 
mine wherein  it  was  deficient,  and  to  try  to  remedy  its  defects.  "We  went  to  our 
county  medical  society  and  told  them  that  the  question  was  simply  one  of  money, 
and  that  we  needed  money  to  employ  legal  counsel.  "We  said  to  them,  If  you 
will  give  us  your  support,  we  will  carry  out  the  provisions  of  the  law.  The  re- 
sult has  been  that  sixty  suits  have  been  brought,  and  in  only  three  has  the  socie- 
ty failed  to  establish  its  case,  and  in  every  offense  the  man  has  been  fined  and 
driven  out  of  practice.  We  got  hold  not  only  of  irregular  practitioners,  but  we 
have  our  hands  on  the  throat  of  one  of  the  colleges  of  this  city.  When  the  gen- 
tleman says  that  the  law  of  1880  protects  quacks  and  protects  irregular  practi- 
tioners, he  makes  a  mistake. 

Dr.  Smith  (Secretary  of  the  Society) :  There  is  an  opinion,  widely  prevalent 
in  the  medical  profession  of  this  State,  that  the  mere  fact  of  registration  in  the 
county  clerk's  office  makes  a  man  a  legally  qualified  practitioner.  It  does  no 
such  thing.  The  law  requires  the  legally  qualified  practitioner  in  his  registration 
to  state  the  authority  under  which  he  claims  to  be  qualified,  and  a  person  who 
has  no  legal  right  to  practice  medicine,  if  he  registers  under  the  law  of  1880, 
wiU  often  furnish  evidence  in  the  statement  he  makes  in  his  registration  that  he 
is  not  legally  qualified ;  so  that  that  law,  instead  of  protecting  quacks,  often 
causes  them  to  furnish  proof  whereby  they  can  be  convicted  of  practicing  ille- 
gally. 

The  introduction  of  the  questions  relating  to  the  law  of  1880  into  the 
code  controversy,  by  the  supporters  of  the  old  code,  was  irrelevant  and  un- 
called for,  as  it  had  no  bearing  on  the  real  issues  under  discussion.  One 
may,  perhaps,  excuse  words  spoken  hastily  in  the  heat  of  debate,  but  we 
can  not  so  readily  overlook  misstatements  made  in  the  calm  seclusion  of  the 
sanctum.  The  following  references  to  the  law  of  1880  are  taken  from  the 
"  Ephemeris  "  for  May,  1883,  pp.  279  and  280  : 

"  The  law  entitled  An  act  to  regulate  the  licensing  of  physicians  and  sur- 
geons, passed  May  20,  1880,  through  the  efforts  of  the  N'ew  YorJc  County  Medi- 
cal Society,"  etc.  (italics  our  own). 

The  fact  is  that  the  Xew  York  County  Society  had  nothing  whatever 
to  do  with  this  law.  It  was  passed  through  by  the  efforts  of  a  committee 
of  the  State  society  appointed  for  the  purpose,  and  the  entire  expense  of  its 
passage,  amounting  to  a  little  less  than  fifty  dollars,  was  borne  by  the  State 


JN   THE  FiTATE  OF  NEW   YORE.  ^^ 

society.     The  committee  itself  was  composed  of  one  member  from  Albany^ 
one  from  Kings,  and  one  from  New  York  comities. 

"This  authorizing  and  licensing  registry  law,  which,  seen  now  in  the  light  of 
more  recent  action,  appears  as  the  first  public  step  taken  in  this  no-code  move- 
ment, levels  all  inequalities,  and  ranks  the  best  names  in  the  profession  with 
those  qualitied  for  no  ])rofession  and  undeserving  of  recognition,  whose  lack  of" 
qualifications  must  be  all  the  more  dangerous  to  the  public  welfare  for  being- 
legally  authorized  and  licensed.  This  class,  though  legally  authorized  in  a 
roundabout  way,  through  diplomas  and  certificates  of  bodies  incorporated  under 
a  general  act,  would  never  have  been  legally  recognized  and  licensed  but  for  this, 
registry  law,  and  the  harm  done  by  thus  recognizing  a  large  number  will  far- 
overbalance  the  good  of  preventing  the  registry  of  a  few,  or  the  prosecution  of  a. 
few  who  may  be  so  incautious  as  to  register  fraudulently." 

With  reference  to  the  foregoing,  we  are  compelled  to  say  that  we  d.o» 
not  remember  to  have  ever  read  two  consecutive  sentences  in  which  were 
to  be  found  so  many  errors  as  to  fact,  and  language  so  well  calculated  to- 
lead  to  false  inferences.  If  the  writer  in  the  "  Ephemeris  "  had  taken  a 
little  care  to  ascertain  the  facts,  he  could  hardly  have  had  the  hardihood  to> 
refer  to  the  registry  law  as  the  "first  step  taken  in  this  no-code  move- 
ment." The  no-code  movement,  as  we  understand  it,  originated  in  a  reso- 
lution introduced  by  Dr.  Roosa,  at  the  meeting  of  the  State  society  in 
1882.  This  movement  has  gained  a  considerable  following,  but,  so  far  as 
we  are  aware,  not  a  single  one  of  the  supporters  of  this  movement  had  any 
hand  or  part  in  the  passage  of  the  Act  of  1880.  We  further  say  that  of 
those  who  did  give  their  time  and  exertions  to  the  furtherance  of  this  regis- 
try law,  not  a  single  one  has  since  appeared  as  an  advocate  of  the  no-code- 
movement. 

"  Levels  all  inequalities."  Every  citizen,  before  voting  at  a  general  elec- 
tion, must  in  this  State  register  his  qualifications;  but  we  fail  to  see  that 
this  brings  down  the  statesman  to  the  level  of  the  pot-house  politician,  or 
the  learned  and  virtuous  to  the  level  of  the  ignorant  and  criminal.  In  one 
respect  only,  not  in  "all,"  does  it  level.  Just  so  the  medical  law  levels  in, 
but  one  respect  only,  and  in  a  very  necessary  respect,  as  it  is  the  only- 
means  by  which  the  State  or  any  one  else  can  learn  the  number  or  the  quali- 
fications of  those  who  are  legally  authorized  to  practice  within  the  borders 
of  the  State.  The  writer  of  this  does  not  feel  himself  specially  degraded 
by  the  fact  that  his  name  is  on  the  same  list  with  the  names  of  physicians 
whom  he  may  deem  of  inferior  professional  quality,  any  more  than  he  does 
that  his  name  goes  on  the  same  polling-list  with  those  whom  he  regards  as 
politically  inferior. 

The  sentence,  "This  class,  though  legally  authorized  in  a  roundabout 
way  through  diplomas  and  certificates  of  bodies  incorporated  under  a  gen- 
eral law,  would  never  have  been  legally  recognized  and  licensed  but  for  this. 
registry  law,"  etc.,  will  bear  a  little  analysis.  It  implies,  first,  that  there- 
exists  a  class  of  practitioners  who  should  never  have  been  legally  author- 


50  THE  STATUS   OF  THE  MEDICAL  PROFESSION 

ized  to  practice.  With  this  sentimeut  we  agree  heartily,  but  the  reader 
should  be  made  aware  that  the  only  incorporated  bodies  that  granted  these 
legal  authorizations  under  "  a  general  law  "  were  the  State  and  county  so- 
cieties acting  in  accordance  with  powers  granted  them  by  various  statutes 
passed  between  the  years  1806  and  1874.  The  reader  might  also  have 
been  informed  that  the  registry  law  of  1880  revokes  these  powers  so  long 
possessed  by  the  county  societies,  and  which  they  in  so  many  instances 
grossly  abused.  In  the  portion  of  the  sentence  that  we  have  quoted  there 
is  a  curious  contradiction.  The  writer  admits  that  a  certain  "  class  "  were 
legally  authorized  by  certain  "  incorporated  bodies,"  and  then  says  that 
they  "  would  never  have  been  legally  recognized  and  licensed  but  for  this 
registry  law."  The  fact  is,  the  registry  law  did  not  legally  authorize  a  sin- 
gle person  to  practice  medicine  who  at  the  time  of  its  passage  was  not  al- 
ready legally  authorized  in  virtue  of  earlier  laws  (with  an  exception  to  be 
noted  in  a  moment).  The  terms  of  the  act  are  sufficiently  explicit,  and  no 
misconception  of  their  import  should  have  arisen  in  the  mind  of  any  one 
Avho  had  read  them.  To  make  this  perfectly  clear,  we  quote  the  words  of 
the  act,  italicizing  the  portions  that  bear  on  the  present  question. 

A  person  shall  not  practice  physic  or  surgery  within  the  State  unless  he  is 
twenty-one  years  of  age,  and  either  has  been  heretofore  authorized  so  to  do  pur- 
suant to  the  laiDS  in  force  at  the  time  of  his  authorization^  or  is  hereafter  author- 
ized so  to  do  as  prescribed  by  chapter  seven  hundred  and  forty-six  of  the  laws 
of  eighteen  hundred  and  seventy-two,  or  by  subsequent  sections  of  this  act. 

Every  person  now  lawfully  engaged  in  the  practice  of  physic  and  surgery 
within  the  State  shall  ....  register. 

After  the  passage  of  the  act,  graduates  in  medicine  only  could  com- 
mence the  practice  of  medicine  in  the  State.  The  exception  that  we  alluded 
to  a  moment  ago  is  in  the  case  of  medical  students  who  had  been  in  prac- 
tice for  ten  years.  These  latter  were  accorded  an  exemption  from  some  of 
the  provisions  of  the  act  for  a  period  of  two  years  from  the  date  of  its 
passage.  We  doubt  if  there  have  been  six  persons  in  the  entire  State  who 
availed  themselves  of  this  exemption. 


m  THE  STATE  OF  NEW   YORK.  5| 


SEVENTH   ARTICLE. 

From  the  New  York  Medical  Journal  for  November  24,  1883. 

A  FEW  days  before  the  meeting  of  tlie  State  society  in  February,  1883, 
a  prominent  bomoeopatMc  physician  of  this  city  said  to  the  writer  that,  if 
the  society  stood  by  the  new  code,  he,  and  probably  other  members,  would 
resign  from  the  homoeopathic  county  society,  and  abandon  their  special 
designation ;  but  that,  if  the  State  society  re-enacted  the  American  code, 
thus  showing  that  the  old  spirit  of  intolerance  still  dominated  the  profes- 
sion, he  should  not  leave  the  homoeopathic  society,  fearing,  with  others, 
that  it  would  be  still  necessary  for  the  protection  of  their  interests  to 
keep  up  a  separate  organization.  As  soon  as  it  was  known  that  the  old 
code  had  not  been  restored,  and  that  the  old-code  party  were  in  the  minor- 
ity, this  gentleman  and  two  other  well-known  homoeopaths  severed  their 
connection  with  the  homoeopathic  society.  A  month  later,  four  others  in 
like  manner  resigned  and  abandoned  their  sectarian  titles.  It  seemed 
probable  that  this  break  from  the  homoeopathic  ranks  would  have  greatly 
increased,  and,  in  the  writer's  judgment,  fully  one  half  of  the  members  of 
the  homoeopathic  society  would  have  abandoned  sectarianism  had  it  not 
been  that  the  old-code  party  made  renewed  efforts  for  supremacy,  and  im- 
pressed many  with  the  belief  that  they  would  ultimately  succeed  in  restor- 
ing the  old  code.  The  bold  front  and  the  assurance  of  success  assumed  by 
the  advocates  of  the  American  code  put  an  immediate  stop  to  resignations 
from  the  homoeopathic  organizations  and  delayed  their  disintegration. 

The  months  of  February  and  March  of  the  present  year  were  devoted 
by  the  supporters  of  the  old  code  to  the  perfection  of  an  organization,  the 
purpose  of  which  was  to  restore,  if  possible,  the  old  code  in  this  State. 
Such  an  organization  was  formed,  and  its  efforts  during  the  year  have 
borne  fruit,  as  we  shall  see  later.  During  the  month  of  March,  Dr. 
Austin  Flint  commenced  a  series  of  papers  in  this  journal  on  "Medical 
Ethics  and  Etiquette,"  which  were  a  commentary  on  the  American  code 
as  viewed  from  the  standpoint  of  its  supporters.  Of  this  commentary  we 
shall  examine  but  a  single  portion,  that  relating  to  the  subject  of  consulta- 
tions. As  we  all  know,  the  rule  of  the  American  Medical  Association 
reads  as  follows  :  "  But  no  one  can  be  considered  as  a  regular  practitioner, 
or  a  fit  associate  in  consultation,  whose  practice  is  based  on  an  exclusive 


52  THE  STATUS   OF  THE  MEDICAL  PROFESSION' 

dogma,"  etc.  ConcerniDg  this,  Dr.  Flint  says  :  "  The  foregoing  section  has 
of  late  been  made  the  subject  of  much  discussion.  Of  the  entire  code,  this 
section  alone  has  occasioned  dissension." 

Dr.  Flint  is  here  mistaken.  The  new-code  party,  or,  to  speak  more 
strictly,  those  who  drafted  the  new  code,  were  dissenters  from  the  old  for 
more  reasons  than  this.  When  they  found  that  prominent  members  of 
the  profession,  including  many  dignitaries  of  the  American  Medical  Asso- 
ciation, were  the  direct  promoters  of  quackery  and  the  use  of  secret  nos- 
trums, through  the  testimonials  given  in  support  of  them,  and  when  tliey 
found  that  the  American-  code  was  apparently  unable  to  repress  these 
abuses,  they  endeavored  in  the  New  York  State  code  to  find  an  effective 
remedy.  An  examination  of  this  code,  especially  its  first  section,  will  show 
how  this  difficulty  was  met,  despite  the  fact  that  an  effort  of  the  same 
kind  encountered  defeat  at  a  recent  meeting  of  the  American  Medical 
Association.  This  certification  of  the  value  of  nostrums  by  prominent 
members  of  the  profession  we  personally  consider  as  one  of  the  most  un- 
fortunate developments  of  the  last  few  years.  It  is  true  that  some  mem- 
bers of  the  profession  in  this  city  fell  into  the  traps  laid  by  cunning 
manufacturers,  but  the  prompt  action  of  the  County  Society  checked  the 
further  extension  of  this  evil.  This  was  effected  by  the  passage  of  a 
special  resolution,  as  the  Committee  on  Ethics  found  that  the  American 
code  was  defective  on  this  point.  When,  in  1882,  the  attention  of  the 
American  Medical  Association  was  called  to  the  abuse  in  question,  its 
Judicial  Council  refused  to  make  any  provision  for  its  abatement,  fearing, 
perhaps,  to  cast  any  reflection  on  those  of  its  prominent  members  who 
were,  or  who  had  been,  advancing  their  own  interests  at  the  expense  of 
the  mass  of  the  profession.  The  first  section  of  the  State  code  we  per- 
sonally regard  as  the  most  important,  and  we  would  be  perfectly  willing  to 
strike  out  all  that  follows  if  by  so  doing  we  could  secure  harmony  on  the 
questions  now  at  issue. 

Dr.  Flint  further  says  :  "  The  Avriter  of  these  remarks  is  one  of  many 
who  think  that  the  code  is  here  open  to  objection,  not,  however,  in  spirit 
or  intent,  but  in  phraseology."  From  this  it  would  seem  that  Dr.  Flint 
approves  the  sentiment  or  spirit  of  the  consultation  clause,  but  does  not 
approve  of  the  language  in  which  it  is  clothed.  Let  us,  therefore,  con- 
sider these  points.  The  intent  of  this  clause  appears  to  be  the  prohibition 
of  consultations  with  certain  persons  in  consequence  of  their  methods  of 
practice,  founded  on  a  belief  in  the  value  of  a  special  exclusive  dogma, 
together  with  the  rejection  of  certain  aids  approved  by  the  regular  pro- 
fession. Dr.  Flint,  however,  a  little  farther  on,  says  that  a  practice  based 
on  an  exclusive  dogma  is  not  valid  ground  for  an  objection  to  consulta- 
tion. "  Any  physician  has  a  right  either  to  originate  or  adopt  an  exclusive 
dogma,  however  irrational  or  absurd  it  may  be."  We  must  here  confess 
our  inability  to  reconcile  the  last  two  sentences  that  we  have  quoted.  That 
Dr.  Flint  should  say  that  he  approves  of  the  "spirit  or  intent"  of  the 


IN  THE  STATE   OF  NEW   YORK.  53 

restrictive  clause  in  the  code,  and.  a  moment  later  say  that  the  adoption  of 
an  exclusive  doctrine  is  not  valid  ground  for  refusing  to  meet  a  practi- 
tioner in  consultation,  certainly  appears  to  us  discrepant  and  inconsistent. 

The  code  having  forbidden  consultation  with  certain  persons,  let  us 
ascertain,  if  possible,  what  persons  are  intended.  On  this  point  Dr.  Flint 
says :  "  At  the  time  when  the  code  was  adopted  by  the  American  Medical 
Association,  the  irregular  practitioners,  so-called,  were  for  the  most  part 
uneducated  men,  whose  practice  was  not  only  based  on  an  exclusive  dogma, 
but  professedly  to  the  rejection  of  the  accumulated  experience  of  the  pro- 
fession, and  of  the  aids  actually  furnished  by  anatomy,  physiology,  patholo- 
gy, and  organic  chemistry.  They  were  steam-doctors,  or  Thomsonians, 
botanical,  or  herb  doctors,  eclectics,  and  the  like.  A  system  of  practice 
based  on  the  dogmas  of  Hahnemann  had  not  then  secured  a  hold  on  popu- 
lar favor.  A  considerable  number  of  those  who  became  homoeopathic 
practitioners,  as  they  are  termed,  were  from  the  ranks  of  the  medical  pro- 
fession, and  had  received  a  regular  medical  education.  Since  the  adoption 
of  the  code,  this  system  has  obtained  a  legal  recognition.  It  has  its 
societies,  colleges,  and  journals.  The  homoeopathic  practitioners  are  an 
organized  class,  distinct  from  the  regular  profession.  They  are  candidates 
for  practice  on  the  ground  of  a  radical  distinction  in  their  therapeutical 
system,  and  it  is  on  this  ground  that  patients  elect  their  services.  Mean- 
while, other  systems  in  antagonism  to  the  regular  profession  are  com- 
paratively insignificant  as  regards  the  number  of  practitioners  and  of 
patients." 

Although  the  foregoing  would  seem  to  imply  that  the  anathema  of  the 
<jode  was  directed  as  much,  if  not  more,  against  the  various  nondescript 
practitioners  of  the  time  as  against  the  homoeopaths,  the  wording  of  the 
€ode  itself  would  almost  to  a  certainty  indicate  that  it  was  specially  in- 
tended to  prevent  consultations  with  the  latter,  as  none  of  the  other  prac- 
titioners had  even  the  pretense  of  an  exclusive  dogma.  Dr.  Flint,  how- 
ever, is,  we  think,  in  error  when  he  states  that  these  practitioners  had  not 
at  that  time  acquired  much  hold  on  popular  favor.  As  early  as  1844 
they  had  acquired  sufficient  hold  to  enable  them  to  secure  the  repeal  of 
the  most  important  section  of  the  Medical  Acts  of  1827,  which,  as  we  have 
already  shown,  opened  wide  the  gates  of  the  State  to  all  forms  of  quackery. 

Dr.  Flint  says  :  "  Since  the  adoption  of  the  code,  this  system  "  (homoe- 
opathy) "  has  obtained  a  legal  recognition."  This  legal  recognition  we 
believe  to  have  been  the  direct  consequence  of  the  code,  and  that  it 
would  never  have  been  obtained  except  for  the  occurrences  that  grew  out 
of  the  operations  of  the  code.  This  is,  of  course,  purely  a  matter  of 
opinion,  but  in  the  present  instance  is  based  on  a  careful  and  extensive 
reading  of  the  controversial  literature  of  those  days. 

Continuing  his  commentary.  Dr.  Flint  says :  "  It  is  fair  to  conclude 
that  the  framers  of  the  code  had  no  feeling  of  illiberality,  and  no  intention 
to  interfere  with  the  practice  of  medicine,  under  any  circumstances,  in  the 


54  THE  STATUS    OF  THE  MEDICAL  PROFESSION 

cause  of  humanity.  The  code  declares  explicitly  that  in  consultations  the 
good  of  the  patient  is  the  sole  object  in  view,  and  enjoins  against  declin- 
ing consultations  on  the  score  of  fastidiousness.  The  restrictions  of  the 
code  are  in  no  wise  inconsistent  with  the  demands  of  humanity  in  cases  of 
emergency.  In  saying  that  certain  practitioners  are  not  to  he  considered 
as  regular  or  fit  associates  in  consultation,  it  is  neither  said  nor  implied 
that  a  physician  should  not  see  a  patient,  even  with  these  practitioners, 
when  humanity  requires  him  to  do  so.  The  tenor  and  spirit  of  the  code 
throughout  are  opposed  to  any  act  of  professional  inhumanity.  Moreover, 
in  particular  cases  the  physician  must  be  the  judge  of  his  duty  in  this 
regard." 

The  view  of  the  code  here  taken  is  certainly  a  novel  one,  and  one 
that,  so  far  as  we  are  aware,  has  never  before  been  publicly  advanced. 
Certainly  the  American  Medical  Association  has  never  given  its  official 
sanction  to  this  explanation  of  its  consultation  clause,  nor  has  any  other 
society,  when  called  on  to  enforce  the  code,  accepted  such  from  delin- 
quents as  a  sufficient  excuse  for  their  misdoing.  It  must  therefore  be 
considered  as  a  purely  personal  view,  and  as  such  does  honor  to  its  pro- 
mulgator. Divested  of  unnecessary  verbiage,  it  simply  means  that  the 
American  code  permits  consultations  with  homoeopaths  in  emergencies,  and 
when  demanded  by  the  dictates  of  humanity,  and  makes  the  individual 
practitioner  the  judge  of  the  necessities  and  proprieties  of  the  case. 

Let  us  compare  this  with  the  consultation  clause  of  the  State  code,  the 
first  sentence  of  which  reads  as  follows  :  "  Members  of  the  Medical  So- 
ciety of  the  State  of  New  York,  and  of  societies  in  affiliation  therewith, 
may  meet  in  consultation  legally  qualified  practitioners."  The  second 
sentence  is  in  antithesis  to,  and  an  explanation  of  the  first,  and  reads  as 
follows:  "Emergencies  may  occur  in  which  all  restrictions  should,  in  the 
judgment  of  the  practitioner,  yield  to  the  dictates  of  humanity."  It  will 
be  noted  that  this  code  neither  obliges,  recommends,  or  encourages  con- 
sultations with  homoeopaths ;  it  simply  permits  them  under  circumstances 
which  are  specified,  and  leaves  the  conscience  of  the  individual  physician 
interested  to  act  as  the  judge  of  the  necessities  of  the  case.  In  what  re-- 
spect,  we  may  ask,  does  this  code  difEer  fi-om  the  American  code  as  inter- 
preted by  Dr.  Flint  ?  ^Ye  believe  the  veriest  hair-splitter  would  find  great 
difficulty  in  establishing  even  the  minutest  difference  between  the  spirit 
and  intent  of  the  one  code  and  the  spirit  and  intent  of  the  other.  And 
yet  this  difference,  whatever  it  may  be,  is  the  nominal  cause  of  the  hostile 
attitude  of  two  important  portions  of  the  profession.  What  reason  is 
there,  then,  for  any  further  prolongation  of  the  contest?  None  whatever, 
so  far  as  the  merits  of  the  case  are  concerned,  unless  perchance  Dr.  Flint's 
interpretation  of  the  code  should  prove  not  to  be  the  correct  one.  There 
can  be  no  question  as  to  the  truth  of  the  assertion  that  until  within  a  very 
recent  period  the  American  code  has  almost  universally  been  interpreted 
as  absolutely  forbidding  mixed  consultations,  under  every  and  all  circum- 


IJV  THE  STATE   OF  NEW   YORK.  55 

stances,  tlie  individual  practitioner  not  being  permitted  to  use  tlie  slightest 
discretion  in  the  matter,  except  at  the  risk  of  professional  animadversion. 
Humanity  or  emergencies  found  no  place  in  the  bosom  of  the  heresy- 
hunter,  whose  special  delight,  apparently,  was  to  detect  some  unfortunate 
practitioner  whose  heart  had  gained  the  better  of  his  prudence.  The 
issue  here  is  plain.  Either  the  old  and  orthodox  interpretation  of  the 
code  must  be  accepted,  or  else  the  one  offered  by  Dr.  Flint.  In  the  latter 
event  it  certainly  seems  to  us  preferable  to  accept  the  phraseology  of  the 
State  code,  the  meaning  of  which  is  clear  and  distinct,  than  to  cling  to  the 
American,  the  language  of  which  apparently  permits  of  the  most  opposite 
interpretation.  Dr.  Flint,  however,  believes  that  consultations  with  homoe- 
opaths should  be  forbidden  for  reasons  which  we  find  for  the  first  time 
stated.  He  says :  "  The  true  ground  for  refusing  fellowship  in  consulta- 
tions, as  in  other  respects,  is  a  '  name  and  an  organization  distinct  from 
and  opposed  to  the  medical  profession.'  "  ..."  It  is  to  be  hoped  that  the 
body  from  which  the  code  emanated — namely,  the  American  Medical 
Association — will  adopt  such  modifications  in  the  phraseology  of  this  sec- 
tion as  will  place  restrictions  on  consultations,  not  on  the  ground  of 
doctrines  or  forms  of  belief,  but  on  separation  from  and  avowed  antago- 
nism to  the  medical  profession."  ..."  If  homoeopathic  practitioners 
abandon  the  organization  and  the  name,  provided  they  have  received  a 
regular  medical  education,  there  need  be  no  restrictions  on  consultations 
other  than  those  belonging  to  other  portions  of  the  code,  whatever  thera- 
peutical doctrines  they  may  hold." 

It  would  appear  from  the  foregoing  that  Dr.  Flint's  main  objection 
to  the  homoeopaths,  from  the  consultation  aspect,  is  the  fact  that  they 
have  formed  medical  associations  outside  those  of  the  regular  medical 
profession,  and  not  in  afiiliation  with  them,  and  that,  as  a  consequence  of 
this,  they  should  be  denied  professional  recognition,  and  their  patients 
should  be  denied  the  advantages  of  regular  advice  when  such  is  needed. 
It  does  not  appear  even  that  emergencies  or  the  calls  of  humanity  would 
permit  an  evasion  of  the  rule.  In  other  words,  the  homoeopathic  practi- 
tioners are  to  be  denied  recognition,  and  their  patients  punished  simply 
because  they  have  established  separate  organizations.  We  believe  the 
existence  of  separate  sectarian  organizations  to  be  a  great  evil — one  of  the 
greatest  that  at  present  afflict  the  body  medical — but  we  are  not  disposed  to 
hold  up  the  homoeopaths  to  utter  condemnation  on  account  of  their  exist- 
ence, when  the  medical  profession  itself  is  mainly  the  cause  of  their  exist- 
ence. We  have  already  shown  that  the  homoeopaths  did  not  leave  the 
regular  societies  voluntarily  and  for  the  purpose  of  organizing  separate 
societies,  but,  in  fact,  were  forced  out  of  the  established  bodies.  A  recent 
writer,*  commenting  on  this  very  point,  says : 

"  But  there  is,  according  to  Dr.  Flint,  still  a  disqualifying  cause  which 
should  exclude  homoeopaths  from  consultations,  and  this  is  the  assumptioa 

*  Dr.  Thomas  Iliin,  in  "  An  Ethical  Symposium,"  New  York,  1883,  pp.  60,  6L 


^Q  THE  STATUS    OF  THE  MEDICAL  PROFESSION 

of  a  name  and  organization  distinct  from  and  opposed  to  tlie  regular 
profession.  There  is  undoubtedl)'  force  in  this  objection,  but,  if  we  look 
at  the  history  of  the  rise  and  growth  of  homoeopathy  in  this  country, 
the  objection  will  be  weakened,  if  not  invalidated.  Surely  the  doctor  is 
-old  enough  to  remember  the  persistent  efEorts  made  in  the  beginning 
l)y  the  homoeopathists,  when  as  yet  they  had  no  organization,  to  be  ad- 
mitted into  our  county  medical  societies,  or  in  the  case  of  members  of  the 
societies  who  adopted  homoeopathy  to  resist  expulsion.  The  numerous 
suits  unsuccessfully  brought  before  the  courts  to  compel  the  societies  to 
admit  or  retain  them  sufficiently  attest  that,  if  they  now  have  a  distinct 
organization,  the  fault  is  not  on  their  side.  We  thrust  them  out  of  doors, 
and  now  it  comes  with  a  bad  grace  from  us  to  give  as  a  reason  for  refusing 
fellowship  with  them  that  they  are  not  in  our  house." 

\Ye  have  no  hesitation,  therefore,  in  asserting  that  Dr.  Flint's  proposi- 
tion savors  neither  of  justice  nor  propriety,  and  that  some  better  excuse 
anust  be  devised  for  excluding  homoeopaths  from  consultation  when  the 
demands  and  needs  of  the  sick  render  such  consultations  desirable. 

While  Dr.  Flint's  commentary  on  the  code  was  being  published  in  the 
columns  of  this  journal  tlie  supporters  of  the  American  code  sought  to 
•effect  an  organization  of  the  physicians  of  this  State  in  opposition  to  the 
State  society,  and  with  the  avowed  purpose  of  resisting  any  modifications 
■of  the  code  that  did  not  originate  with  the  American  Medical  Association. 
A  vigorous  canvass  of  the  State  was  made  in  behalf  of  this  organization, 
;and  numerous  signatures  were  obtained  to  a  paper  pledging  its  signers  to 
stand  by  the  American  code.  This  action  necessitated  the  formation  of 
another  association,  one  opposed  to  the  re-enactment  of  the  old  code. 
This  latter  body  forwarded  to  each  member  of  the  regular  profession  of  the 
:State  a  postal-card  bearing  on  its  back  the  following  words :  "  I,  the  un- 
'dersigned,  am  opposed  to  the  present  code  of  ethics  of  the  American 
Medica?  Association,  and  approve  of  the  use  of  all  honorable  means  to  pre- 
vent its  re-enactment  in  the  State  of  Xew  York."  The  majority  of  those 
■who  dgned  this  declaration  and  mailed  the  card  back  to  New  York  simply 
.attached  their  signatures  and  addresses.  Many,  however,  added  a  few . 
-words  of  comment.  All  of  the  cards  that  were  returned  to  the  city  came 
Hinder  the  eye  of  the  writer,  and  from  them  we  have  copied  the  following 
words  of  comment : 

"  arid  all  other  codes,  as  thirty  years  adherence  to  it  has  proved  its  useless- 
mess."— S.  F.  McF. 

'•  and  so  is  the County  Medical  Society  as  a  body." — R.  L. 

"  I  am  strongly  in  favor  of  the  abolition  of  all  codes,  considering  any  code 
unnecessary  for  the  guidance  of  a  gentleman,  and  useless  for  the  restraint  of 
others."—!.  C.  W. 

"I  think  that  the  old  code  was  a  good  one  when  adopted,  but  there  are 
reasons  why  it  should  now  be  rejected." — S.  P.  S. 

"  I  have  practiced  my  profession  since  1845,  and  do  not  hesitate  to  say  that 


IN  THE  STATE  OF  NEW   YORK.  57" 

I  do  not  recall  the  time  or  instance  when  the  old  code  governed  the  conduct  of 
men  of  good  sense  or  repute." — E.  V.  K. 

"  I  would  much  rather  prefer  no  code  at  all.  But,  being  obliged  to  choose 
under  existing  circumstances,  I  say,  emphatically,  give  me  the  new  code." — M. 
G.  P. 

"I  heartily  indorse  this  card.  Had  the  same  position  been  taken  twenty 
years  ago  it  would  have  been  better  for  the  people  and  the  profession."' — J.  R. 

"  The  more  liberty  we  have,  the  greater  amount  of  good  we  can  do." — L.  B. 

"I  regard  the  new  code  as  a  most  unfortunate  and  unwise  substitute  for  the 
•oW  code.     Abolish  the  whole  thing." — J.  M.  N.  K. 

"I  have  protested  against  it  for  eighteen  years,  and  will  do  all  in  my  power 
to  aid  in  its  overthrow." — 0.  H.  A. 

"I  believe  in  each  physician  practicing  medicine  according  to  the  dictates  of 
his  own  conscience." — F.  W.  0. 

"  Hope  we  will  succeed.  New  York  can  afford  to  be  not  represented  at  the 
American  Medical  Association.  If  we  make  a  bold  stand  I  think  we  will  win 
— we  have  the  right  side,  any  way.     I  am  for  no  codey — R.  F. 

"  After  obeying  and  carefully  observing  the  rules  of  the  old  code  for  many 
long  years,  I  have  become  strongly  opposed  to  it,  and  am  in  full  accord  with  the 
new  code;  and  am  willing  to  do  what  little  I  can  to  maintain  it  in  the  State  of 
New  York, 

"I  see  its  opposers  are  working  hard,  almost  moving  heaven  and  earth  to 
bring  about  its  repeal ;  but  I  do  not  think  they  can  succeed.  ...  It  (the 
American  code)  is  not  in  accord  with  the  spirit  of  the  age ;  it  is  against  the 
common-sense  law  of  the  land,  and  the  best  sentiment  of  all  classes  of  society." 
— W.  B.  A. 

"  I  think  a  code  of  ethics  for  the  medical  profession  as  unnecessary  as  a  book 
of  etiquette  for  a  true  gentleman." — H.  F.  B. 

'•  An  unwritten  code  is  as  binding  to  an  honorable,  honest  man,  and  a  writ- 
ten code,  however  stringent  or  liberal,  will  have  no  iniiuence  over  the  conduct 
of  any  others." — H.  A.  B. 

'•  I  prefer  not  to  be  tightened  up  by  any  code;  shall  in  the  future  do  as  I 
have  done  in  the  past — uphold  the  dignity  and  honor  of  my  profession,  in  my 
•own  way,  to  the  best  of  my  judgment." — J.  R.  B. 

"and  I  am  opposed  to  the  pretentious  and  hypocritical  old  code  of  the  New 
York  State  Medical  Society." — L.  C. 

"  The  new  code  does  not  cause  irregulars  to  rejoice,  nor  does  it  encourage 
a  single  wrong ;  the  new  code  is  legal ;  it  is  the  voice  of  the  age.  It  is  prog- 
ress."—S.  J.  P. 

"Most  heartily."— F.  W.  A. 

"In  the  name  of  humanity,  decency,  and  liberal  progress.  Amen!  " — H.  L. 

"I  did  not  approve  of  the  change,  but,  since  it  has  been  done,  would  not 
turn  back."— 0.  S.  P. 

"I  would  prefer  no  code,  but,  if  we  must  have  one,  let  it  be  liberal." — 0. 
€.  F. 

"believing  no  code  as  effective  as  any  code." — J.  H.  F. 

"  because  it  can't  be  lived  up  to  in  actual  practice.  We  must  meet  irregu- 
lars, and,  if  gentlemen,  we  must  treat  them  as  such." — P.  K.  S. 

"I  am  in  favor  of  free  consultations." — J.  T.  L. 

"Patients  first,  ethics  next,  and  liberal  opinions  all  the  time." — 0.  M.  McL. 


58  TEE  STATUS    OF  THE  MEDICAL  PROFESSION 

"I  am  in  favor  of  the  present  code  of  ethics  of  the  American  Medical  Asso- 
ciation, and  approve  of  all  honorable  means  to  effect  its  re-enactment  in  the 
State  of  New  York,  hoping  that  we  may  soon  have  it  amended  in  a  way  that 
will  leave  all  at  liberty  to  council  with  all  whom  they  please,  and  not  admit  (as 
the  present  code  does)  that  the  Legislature  is  competent  to  say  with  whom  it  is- 
proper  and  right  to  meet  in  consultation.  A  code  of  medical  ethics  should 
ignore  all  sects  in  medicine." — L.  B. 

The  foregoing  comments  certainly  indicate  a  wide  diversity  of  feeling 
on  the  questions  involved  in  the  present  discussion,  and  the  different  stand- 
points from  which  they  are  viewed. 

The  next  important  event  in  connection  with  the  code  controversy 
occurred  at  a  meeting  of  the  Xew  York  Academy  of  Medicine  in  April  last. 
This  body,  by  virtue  of  its  charter,  is  entitled  to  representation  in  the 
State  society.  Its  by-laws,  however  (unlike  those  of  the  county  societies),, 
are  not  subject  to  the  revision  of  the  State  society.  The  Academy  has- 
generally  been  regarded  as  the  peculiar  stronghold  of  the  conservatives,  it 
being  claimed  that  they  possessed  a  large  majority  in  that  body.  Some 
question  having  arisen  as  to  the  right  of  the  Academy  to  representation 
in  the  American  Medical  Association  after  the  exclusion  of  the  New  York 
State  society,  it  seemed  important  to  the  old-code  party  to  place  the 
Academy  distinctly  on  record  as  a  supporter  of  the  American  code.  At  a 
meeting  of  the  Academy,  held  on  the  19th  of  April,  Dr.  Austin  Flint,  Jr.,. 
introduced  a  series  of  resolutions  disavowing  sympathy  with  the  action  of 
the  State  society,  and  pledging  the  Academy  to  renewed  allegiance  to  the 
code  of  the  American  Medical  Association.  The  Committee  on  Admis- 
sions of  the  Academy  was  also  directed  to  report  for  membership  only 
such  persons  as  would  pledge  themselves  to  support  the  old  code.  The? 
resolutions  were  adopted  by  a  large  majority,  obtained  by  the  very  simple 
expedient  of  assembling  the  old-code  members  by  means  of  a  secret 
circular,  and  without  notice  of  the  proposed  action  to  the  other  side.  The 
detailed  proceedings  of  this  meeting  of  the  Academy  have  obtained  a  very 
wide  publicity,  and  need  not  here  be  rehearsed.  It  was  at  this  meeting- 
that  Dr.  Flint,  Jr.,  first  appeared  as  the  virtual  leader  of  the  old-code 
element,  and  indicated  that  the  policy  to  be  pursued  would  be  characterized 
by  the  fortiter  in  re,  rather  than  the  suaviter  in  mode.  In  other  words, 
opposition  was  to  be  overcome  by  brute  force,  rather  than  by  an  appeal  to 
argument  and  reason.  This,  indeed,  was  so  thoroughly  characteristic  of 
the  methods  that  for  years  have  prevailed  in  the  American  Medical  Asso- 
ciation itself  that  we  need  not  be  surprised  at  anything  that  is  done  in 
its  name.  The  effect  of  this  action  in  the  Academy  was  not  all  that  was- 
hoped  by  its  supporters.  Instead  of  strengthening  the  old-code  party  in 
this  city,  it  distinctly  weakened  it.  Many  gentlemen  whose  bias  was  in 
favor  of  the  old  code,  and  who  were  Avilling  to  vote  for  its  restoration,. 
recoiled  at  the  means  that  the  leaders  of  their  party  seemed  disposed  to 


IN  THE  STATE   OF  NEW   YORK.  59 

adopt,  and  declined  to  follow  them  farther.      This  was  most  conclusively 
shown  a  few  months  later. 

The  American  Medical  Association  met  early  in  June,  and  when  the 
members  assembled  they  found  themselves  confronted  with  an  order  from 
the  Judicial  Council,  notifying  them  that  they  would  not  be  permitted  ta 
reo-ister  and  take  part  in  the  proceedings  of  the  meeting  unless  they 
signed  a  pledge  of  fidelity  to  the  code  of  ethics.  This  pledge  termi- 
nated with  the  words :  "  I  will  use  my  best  efforts  to  maintain  the  same, 
and  in  testimony  whereof,  I  hereunto  affix  my  name."  A  careful  exami- 
nation of  the  constitution  and  by-laws  of  the  association  fails  to  discover 
any  authority  for  this  action  of  the  Judicial  Council.  It  was  a  pure  assum].)- 
tion  on  their  part,  for  which  they  possessed  no  warrant  whatever.  This 
action  of  the  council  does  not  surprise  us;  in  fact,  nothing  that  this  body 
should  do,  or  attempt  to  do,  would  surprise  us.  We  were,  however,  im- 
measurably surprised  that  any  of  the  members  of  the  association  were 
willing  to  be  thus  deprived  of  their  liberty  of  action,  or  to  deprive  their 
fellow-members  of  theirs.  We  believe  that  the  majority  of  the  signers 
could  hardly  have  been  aware  of  the  full  intent  of  the  pledge  they  were 
singing,  as  it  virtually  binds  them  to  use  their  best  efforts  to  maintain 
forever,  without  change,  the  present  code  of  the  American  Medical  Asso- 
ciation. 

We  see  in  this  act  of  the  Judicial  Council  and  of  the  association  a 
striking  example  of  the  dangers  that  beset  every  unchartered  and  irre- 
sponsible body ;  a  clique,  once  getting  into  power,  hold  the  members  at 
their  mercy,  and  are  enabled  to  trample  on  their  rights  at  any  moment, 
without  fear  of  being  held  accountable,  either  as  individuals  or  as  an  asso- 
ciation. Not  so  in  a  chartered  society,  even  with  by-laws  identical  with 
those  of  the  American  Medical  Association.  Such  a  society  would  hav& 
been  compelled  to  admit  its  regular  members,  irrespective  of  signing  or 
not  signing  such  a  pledge.  Doubtless  the  old-code  members  of  the  New 
York  Academy  of  Medicine  would  be  very  glad  to  exclude  from  the  meet- 
ings such  of  its  members  as  do  not  approve  its  present  code  and  by-laws ;: 
but  they  know  such  an  attempt  would  prove  futile.  In  a  chartered  society, 
every  member  knows,  or  can  readily  learn,  his  rights,  and  neither  a  ring, 
clique,  nor  even  a  majority  in  the  society,  can  deprive  him  of  them  against 
his  will.  In  an  unincorporated  society,  however,  anything  may  be  done 
that  at  any  time  a  majority  approves,  and  there  is  no  redress  for  those 
who  may  be  injured  thereby.  For  instance,  in  the  American  Medical 
Association  a  majority  could,  by  mere  vote,  pass  a  resolution  expelling  all 
members  who  are  opposed  to  them,  and  the  expelled  members  would  not 
be  able  to  defend,  or  regain,  their  rights  through  an  appeal  to  the  courts. 
In  fact,  something  very  like  this  was  done  a  few  years  ago.  The  writer 
attended  a  meeting  of  the  association  in  1865,  and  paid  his  fee  of  fiv& 
dollars,  which  at  that  time  entitled  him  to  life-membership,  without  further 
payment  of  dues.     A  few  years  later  he,  in  common  with  other  members. 


^0  THE  STATUS   OF  THE  MEDICAL  PROFESSIOlS 

who  had  joined  the  association  on  similar  terms,  was  informed  that  his 
life-membership  would  be  forfeited  unless  he  maintained  it  by  a  further 
annual  payment  of  five  dollars.  This  was  a  most  unmistakable  breach  of 
contract,  and  violated  the  commonest  principles  of  honesty  and  morality. 
The  instance  is  cited  simply  as  an  example  of  the  many  arbitrary  acts  of 
"the  association,  and  to  show  how  any  act  may  be  done  by  any  voluntary, 
:unincorporated  society.  Despite  these  facts,  there  are  those  who  desire  to 
see  the  incorporated  societies  of  this  State  subjected  to  the  control  of  such 
a  body.  We  can  hardly  believe  that  the  gentlemen  holding  these  views 
have  given  any  verj-  careful  consideration  to  the  subject.  In  common  with 
the  majority  of  the  profession,  we  approve  of  the  existence  of  a  national 
medical  association,  but  it  should  be  one  devoted  to  scientific  pursuits  only, 
and  should  not  attempt  to  interfere  with  medical  politics  in  any  manner. 
If  the  American  Medical  Association  would  reorganize  on  such  a  basis, 
New  York  State,  we  believe,  would  be  unanimous  in  its  support.  If  it  con- 
tinues as  it  is,  its  existence  is  but  a  question  of  a  very  few  years. 

The  refusal  of  the  American  Medical  Association  to  permit  those  who 
did  not  approve  its  code  to  participate  in  the  proceedings  of  the  Cleveland 
meeting,  thereby  preventing  any  discussion  of  the  subject,  has  proved  to 
be  one  of  the  most  valuable  allies  to  the  cause  of  the  New  York  State 
■code.  It  was  generally  supposed  that  the  advocates  of  the  American  code 
in  this  State  would  endeavor  to  secure  desirable  modifications  at  the 
Cleveland  meeting,  and  many  signatures  were  obtained  to  the  old-code 
papers  in  consequence  of  this  impression.  The  warrant  for  this  belief  was 
the  fact  that  Dr.  Flint  in  his  commentaries  had  expressed  his  dissatisfac- 
tion with  the  code,  as  already  shown  in  the  present  paper,  together  wdth 
the  peculiar  wording  of  the  papers  sent  for  signatures.  In  fact,  many 
signatures  were  obtained  on  the  express  representation  that  a  change  of  the 
code  would  be  attempted  by  the  members  from  New  York.  No  such  at- 
tempt was  made,  and  some  of  the  old-code  signers,  now  fnlly  appreciating 
the  fact  that  no  change  may  be  expected  by  the  association,  and  not  ap- 
proving the  code  as  it  stands,  have  withdrawn  their  support  and  influence, 
and  have  given  them  to  the  State  code.  We  believe  that  a  majority  of  the 
old- code  supporters  gave  their  signatures  not  from  a  fondness  for  the  old 
•code,  but  from  a  belief  that  all  changes  in  it  should  originate  with  the 
ass  relation.  Many  have  the  idea  that  the  association  possesses  some  sort 
of  jurisdiction  over  the  profession  of  the  State,  and  that  resistance  to  its 
by-laws  is  a  species  of  rebellion  against  constituted  authorities.  This  idea 
is  an  absolutely  false  and  mistaken  one.  The  association  has  no  more 
jurisdiction  over  the  diiierent  State  societies  than  the  American  Gynae- 
cological or  the  American  Dermatological  Society  has.  Moreover,  there  is 
no  process  by  which  it  could  obtain  such  jurisdiction.  No  single  State  in 
the  Union  could  give  it  a  charter  that  would  enable  its  power  to  be  exerted 
Taeyond  the  limits  of  the  State  granting  the  charter  ;  while  the  best  that  the 
United  States  could  do  would  be  to  grant  a  charter  the  jurisdiction  of 


IN  THE  STATE   OF  NEW   YORK. 


61 


which  would  be  coextensive  with  the  District  of  Cohimbia.     Conoress  has 
for  instance,  the  power  to  establish  a  medical  college  within  the  limits  of 
the  District,  and  to  make  the  diplomas  of  the  college  licenses  to  practice 
within  that  area,  but  it  does  not  possess  the  power  to  make  them  valid  in 
any  State  in  the  Union.     Such  power  exists  solely  in  the  respective  States. 

The  profession  of  this  State,  and  of  other  States  as  well,  should  remem- 
ber that  they  are  not  doctors  by  divine  right,  or  the  grace  of  God,  but 
simply  through  the  will  of  the  various  State  Legislatures.  It  is  this 
which  gives  them  a  legal  right  to  call  themselves  "  doctors,"  and  permits 
them  to  practice  their  profession.  The  Constitution  of  the  United  States 
guarantees  a  certain  amount  of  freedom  in  the  exercise  of  religious  privi- 
leges, but  it  makes  no  such  guarantees  as  regards  the  exercise  of  the  legal, 
medical,  or  any  other  profession  or  trade.  These  rights  the  States  reserved 
at  the  time  of  the  formation  of  the  Union,  and  since  then  have  never 
yielded  their  prerogative  to  the  national  authorities.  The  action  of  the 
New  York  State  society  has  been  likened  to  the  action  of  the  Southern 
States  at  the  commencement  of  the  late  "  unpleasantness."  It  should  be 
remembered  that  at  the  time  of  the  formation  of  the  Union  the  various 
States  entered  into  a  compact  with  each  other,  and  that  their  secession  was 
a  breach  of  that  compact.  The  Medical  Society  of  the  State  of  New  York, 
however,  never  formed  any  compact,  or  entered  into  any  contract  with  the 
American  Medical  Association  or  with  any  of  the  other  States,  nor,  so  far 
as  we  are  aware,  did  any  other  State.  There  is  therefore  no  analogy 
between  the  relations  of  the  various  States  to  the  Union  and  the  purely 
voluntary  relation  of  the  different  State  societies  to  the  American  Medical 
Association.  The  latter  can,  at  any  time  it  chooses,  and  for  any  cause, 
refuse  to  admit  the  delegates  from  any  of  the  States.  In  like  manner  any 
of  the  State  societies  can  sever  its  existing  connection  with  the  American 
Medical  Association  whenever  it  deems  it  to  be  to  the  interest  of  the  pro- 
fession of  the  State  to  do  so. 

In  1882  the  New  York  society  considered  that  it  was  better  to  relin- 
quish its  connection  with  the  American  Medical  Association  than  to  con- 
tinue the  connection,  subject  to  the  objectionable  by-laws  of  the  latter 
body.  The  association,  on  the  other  hand,  thought  it  would  be  better  to 
dispense  with  the  representatives  from  New  York  than  to  alter  its  by-laws. 
This  it  had  a  perfect  right  to  do,  and  no  one,  so  far  as  we  are  aware,  has 
found  any  fault  with  it  for  so  doing.  The  only  power  possessed  by  the 
association  is  of  a  moral  nature  ;  legal  power  it  has  none.  We  should 
therefore  judge  its  actions  by  the  moral  standard  alone.  The  repudiation 
of  its  financial  contract  with  its  early  permanent  members,  and  the  recent 
refusal  to  admit  certain  of  its  members,  who  under  its  by-laws  were  entitled 
to  admission,  should  be  sufficient  to  place  the  seal  of  condemnation  upon 
the  association,  judged  by  the  standard  we  have  alluded  to. 

During  the  summer  months  there  was  an  apparent  cessation  of  active 
operations  by  both  parties.     Early  in  October,  however.  Dr.  Fordyce  Bar- 


^2  THE  STATUS   OF  TEE  MEDICAL  PROFESSION 

ter,  the  president  of  the  New  York  Academy  of  Medicine,  sent  to  each  of 
the  members  a  recommendation  that  the  by-laws  of  the  Academy  be  altered 
in  certain  respects.  The  Academy  came  into  existence  by  virtue  of  a  char- 
ter from  the  State  granted  in  the  year  1847.  This  charter  conveyed  cer- 
tain rights  and  privileges,  none  of  them,  however,  of  a  medico-political  na- 
ture. The  Academy,  shortly  after  its  organization,  assumed  such  powers, 
and,  through  its  moral  influence,  exercised  them  for  many  years.  The 
alterations  of  the  by-laws  proposed  by  Dr.  Barker  involved  a  repudiation 
of  its  former  political  aspirations,  and  the  resumption  of  a  purely  scientific 
status,  as  contemplated  in  its  original  charter.  To  accomplish  this  end  it 
would  be  necessary  for  the  Academy  to  repeal  its  allegiance  to  the  Ameri- 
can code.  This  would  require  a  three-fourths  vote  of  its  members.  When 
the  matter  came  to  a  decision,  it  was  found  that  a  three-fourths  vote  was 
not  in  favor  of  the  repeal  of  the  code,  but,  to  the  surprise  of  many,  there 
was  a  very  decided  majority  in  favor  of  such  action.  The  Academy  there- 
fore stands  to-day  as  adverse  to  the  old  code,  but  without  power  to  repeal 
it,  while  the  minority  who  are  in  favor  of  the  old  code  have  no  power  to 
enforce  it  against  the  wishes  of  a  stronger  adverse  sentiment.  This  is  cer- 
tainly an  anomalous  state  of  affairs,  which  can  not  continue  for  any  great 
length  of  time. 

For  some  months  it  had  been  claimed  by  the  supporters  of  the  old  code 
that  the  general  sentiment  of  the  profession  in  this  city  was  in  favor  of 
the  re-enactment  of  the  American  code.  It  was  asserted  that  a  majority 
of  the  County  society  were  in  favor  of  such  action.  The  test  was  made  at 
the  annual  election  of  officers  in  October.  On  this  occasion  both  parties 
brought  to  the  polls  their  full  voting  strength.  On  counting  the  votes, 
it  was  found  that  there  were  220  in  favor  of  restoring  the  old  code,  and 
3*75  opposed  to  so  doing.  It  seems  quite  certain  that  the  old-code  associa- 
tion had  secured,  early  in  the  spring,  a  sufficient  number  of  supporters  to 
give  them  hopes  of  success.  When  the  matter  came  to  a  vote,  however, 
both  in  the  Academy  and  in  the  County  society,  the  result  showed  that 
there  had  been  many  breaks  from  the  old-code  ranks.  Many  gentlemen, 
who  in  the  spring  had  hastily  signed  the  old-code  papers,  on  careful 
examination  of  the  subject  reconsidered  their  action.  Many  others  re- 
garded the  occurrences  that  took  place  at  the  April  meeting  of  the  Acade- 
my of  Medicine  a  sufficient  ground  for  withdrawing  their  sympathies 
from  the  leaders  of  the  majority  on  that  occasion.  A  still  greater  num- 
ber, however,  we  are  satisfied,  abandoned  the  fortunes  of  the  old-code 
party  in  consequence  of  the  failure  of  the  leaders  of  that  party  to  even 
attempt  to  secure  changes  in  the  American  code  that  so  many  of  their 
followers  considered  desirable. 

We  may,  I  think,  consider  the  code  question  as  definitely  settled,  in 
this  city  at  least,  so  far  as  regards  the  restoration  of  the  code  of  ethics 
of  the  American  Medical  Association.  The  County  society,  the  only 
body  that  can  legitimately  consider  the  question,  at  the  last  election,  as 


IN   THE  STATE   OE  NEW    YORK. 


63 


on  every  previous  occasion  on  Avhicli  tlie  matter  has  been  brought  for- 
ward, distinctly  expressed  its  sentiments  in  opposition  to  the  old  code. 
It  is  true  that  the  question  can  hardly  be  said  to  have  reached  a  final 
solution  in  the  Academy  of  Medicine.  This  body,  with  a  limited  member- 
ship, possesses  but  a  limited  influence  on  the  mass  of  the  profession, 
and  it  is  of  very  little  practical  consequence  which  way  it  is  there 
decided.  The  liberals,  it  is  true,  are  in  the  majority,  and  will,  without 
the  slightest  doubt,  remain  so,  and  may  expect  accessions  both  from  the 
ranks  of  the  present  conservatives  and  from  among  those  who  in  the 
future  become  members.  As  we  have  already  shown,  the  code  has  been 
for  many  years  practically  in  abeyance  in  the  Academy,  so  far  as  its 
enforcement  was  concerned,  and  there  is  but  little  likelihood  that  its 
vitality  will  ever  again  be  tested  in  that  body.  Such  being  the  case,  we 
are  perfectly  willing  that  those  who  profess  to  admire  the  code  should 
continue  to  wear  it  as  an  ornament  and  a  phylactery. 

Before  closing  this  series  of  papers,  one  or  two  questions  of  impor- 
tance require  notice.  As  we  have  already  shown,  certain  of  the  county 
societies  of  this  State  repudiated  the  action  of  the  State  society  in  the 
matter  of  the  code,  and  declared  that  they  would  stand  by  the  old  code 
and  retain  it  among  their  by-laws. 

It  has  been  thought  by  some  that  such  action  on  the  part  of  the  county 
societies  would  forfeit  their  title  to  representation  in  the  State  society. 
Such,  however,  is  not  the  case.  There  is  no  jjrovision  in  any  of  the  statutes 
by  which  the  State  society  is  empowered  to  deny  the  county  societies  the 
right  of  representation,  no  matter  how  rebellious  they  may  be  as  regards 
the  edicts  of  the  former  body.  The  only  way  in  which  the  State  society 
can  defend  itself  in  the  matter  is  by  a  direct  application  to  the  Legislature 
to  have  the  charters  of  tiie  offending  societies  revoked,  as  provided  for  in 
Sec.  2  of  Article  V  of  the  by-laws  of  the  State  society.  There  is  little  doubt 
that,  in  the  present  state  of  public  opinion,  if  such  application  were  made 
to  the  Legislature,  the  request  of  the  State  society  would  be  promptly 
granted.  The  county  societies,  however,  should  be  aware  that  any  code 
or  by-laws  they  adopt  contrary  to  the  wishes  of  the  State  society  are  ab- 
solutely illegal  and  null  and  void.  The  importance  of  this  matter  suggested 
to  the  writer  the  advisability  of  obtaining  the  opinion  of  legal  counsel  con- 
cerning it,  and  to  this  end  we  submitted  the  following  question :  What  will 
be  the  effect  if  a  county  medical  society  adopts  a  by-law  w^hich  is  not  in 
accordance  with  the  ordinances  of  the  Medical  Society  of  the  State  of  New 
York,  or  which  does  not  receive  the  approval  of  said  State  society  ?  The 
answer  to  this  question  was  as  follows  : 

"By  the  provisions  of  Sec.  14  of  the  Act  of  1813  (Chap.  94),  it  is  made 
'■  lawful  for  the  respective '  (county)  '  societies  to  make  such  by-laws  .... 
as  they  shall  think  fit  and  proper,  provided  ....  that  the  by-laws  .... 
shall  not  be  repugnant  to  the  by-laws,  rules,  and  regulations  of  the  Medical 
Society  of  the  State  of  New  York.' 


54  THE  STATUS   OF  THE  MEDICAL  PROFESSIOJV. 

"And,  by  the  provisions  of  Sec.  1  of  Cliap,  445  of  the  laws  of  1866,  it 
is  declared  to  be  'lawful  for  any  county  medical  society  in  this  State  .... 
to  establish  such  rules  and  regulations  for  the  government  of  its  members 
as  they  may  deem  fit,  provided  the  action  of  such  societies  receive  the 
sanction  of  the  said  State  medical  society.' 

"  I  am,  therefore,  of  opinion  that  any  such  action  on  the  part  of  a  county 
society  would  be  null  and  void  and  of  no  effect;  in  other  words,  as  the 
law  stands,  the  county  societies  can  not  adopt  a  by-law  such  as  is  sug- 
gested by  the  question,  and  any  attempt  to  do  so  would  be  idle  and  of  no 
avail." 

We  here  leave  the  question  of  the  codes  and  the  status  of  the  profession, 
vi'ith  the  statement  that  we  have  endeavored  to  be  accurate  as  to  facts, 
logical  as  to  inferences,  and  moderate  but  candid  in  the  expression  of 
opinion.  We  can  not  but  hope  that  the  whole  matter  will  receive  a  speedy 
solution,  and  one  that  will  commend  itself  to  the  great  majority  of  the  pro- 
fession in  this  State. 


The  lew  York  ledical  Journal, 

A  WEEKLY  REVIEW  OF  MEDICINE. 


Published  by 

D.  Appleton  &  Co. 


Edited  by 

Frank  P.  Foster, 


M.  D. 


The  New  York  Medical  Jouenal,  now  in  the  nineteenth  year  of  its 
publication,  is  published  every  Saturday,  each  number  containing  twenty- 
eight  large,  double-columned  pages  of  reading-matter.  By  reason  of  the 
condensecl  form  in  which  the  matter  is  arranged,  it  contains  more  reading- 
matter  than  any  other  journal  of  its  class  in1:he  United  States.  It  is  also 
more  freely  illustrated,  and  its  illustrations  are  generally  better  execixted, 
than  is  the  case  with  other  weekly  journals. 

It  has  a  large  circulation  in  all  parts  of  tlic  country,  and,  since  the  pub- 
lishers invariably  follow  the  policy  of  declining  to  I'uniish  the  Journal  to 
subscribers  who  fail  to  remit  in  due  time,  its  circulation  is  bona  fide.  It  is 
largely  on  this  account  that  it  is  enabled  to  obtain  a  lugh  class  of  contrib- 
uted articles,  for  authors  know  that  through  its  columns  they  address  the 
better  part  of  the  profession ;  a  consideration  which  has  not  escaped  the 
notice  of  advertisers,  as  shown  by  its  increasing  advertising  patronage. 

The  special  departments  of  tlie  Journal  are  as  follows: 

LECTURES.— The  frequent  publication  of  material  of  this  sort  is  a  prominent  fea- 
ture, and  pains  are  taken  to  choose  such  as  will  prove  valuable  to  the  reader. 

OKIGINAL  COMMUNICATIONS.— In  accepting  articles  of  that  class,  regard  is 
had  more  particularly  to  the  wants  of  the  general  practitioner,  and  all  the 
special  branches  of  medicine  are  duly  represented. 

BOOK  NOTICES. — Cun-ent  publications  are  noticed  in  a  spirit  of  fairness,  and  with 
the  sole  view  of  giving  information  to  the  reader. 

CLINICAL  EEPOltTS  are  also  a  regular  feature  of  the  Journal,  embracing  clinical 
records  from  the  various  hospitals  and  clinics,  not  only  of  New  York,  but  of 
various  other  cities,  together  with  clinical  contributions  from  private  practice. 

EDITORIAL  ARTICLES  are  numerous  and  carefully  written,  and  we  are  able  to 
give  timely  consideration  to  passing  events. 

MINOR  PARAGRAPHS.— Unrlor  this  heading  are  given  short  comments  and 
notes  on  passing  events. 

NEWS  ITEMS  contain  the  latest  news  of  interest  to  the  profession. 

OBITUARY  NOTKS  announce  the  deaths  which  occur  in  the  ranks  of  the  profes- 
sion, with  a  brief  history  of  each  individual  when  practicable. 

SOCIETY  PROCEEDINGS  are  given  promptly,  and  thos.'  of  a  great  number  of 
societies  figure.  At  the  same  time  we  select  for  publication  only  such  as  we 
think  profirable  to  our  readers. 

REPORTS  ON  THE  PROGRESS  OP  MEDICINE  constitute  a  feature  of  the 
Journal  which  we  have  reason  to  think  is  highly  valued  by  our  readers. 

MISCKLLANY  includes  matter  of  general  interest,  and  sp.ace  is  .also  given  for 

NEW  INVENTIONS  and  LETTERS  TO  THE  EDITOR. 

As  a  whole,  we  are  warranted  in  saying  that  the  New  York  Medical 
Journal  is  regarded  with  the  highest  ihvor  by  its  readers  and  by  its  con- 
temporaries. 

Subscription  price,  $5.00  per  annum. 


«er'' 


COLUMBIA  UNIVERSITY 

This  bQok  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  tlie  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 


DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

C2e'638)M50 

R291 


P62 


Piffard 
Status  of  the  medical  profession 
in  the  state  of  Hew  York 

C.  U.  BINDERY 


